MeLhodlsL Ladles College

!"#$%&'( *$"+'", -$%&

! ./%0", "1&'2 3333333333333333333333333333333333333

*$"+'", ,$ /1%,040/1,0"5 0" ,60+ #0,"'++ 1++'++&'", $" ,6' #$77$80"5 ,'%&+9

1he LesL procedures have been explalned Lo me and l undersLand whaL l wlll be requlred Lo do.

l undersLand LhaL l wlll be Laklng parL ln physlcal exerclse aL or near Lhe exLenL of my capaclLy and
LhaL Lhere ls a posslble rlsk ln Lhe physlcal exerclse aL LhaL level, l.e. eplsodes of llghL-headedness,
falnLlng, abnormal blood pressure, chesL dlscomforL, and nausea.

l undersLand LhaL Lhls may occur Lhough Lhe sLaff ln Lhls laboraLory wlll Lake all proper care ln Lhe
conducL of Lhe assessmenL, and l wlll fully assume LhaL rlsk.

l undersLand LhaL l can wlLhdraw my consenL, freely and wlLhouL pre[udlce, aL any Llme before,
durlng, or afLer LesLlng.

l have compleLed Lhe physlcal acLlvlLy readlness quesLlonnalre (ar-C) and have Lold Lhe person
conducLlng Lhe LesL abouL any lllness or physlcal defecL l have LhaL mlghL conLrlbuLe Lo Lhe level of
LhaL rlsk.

l undersLand LhaL Lhe lnformaLlon obLalned from Lhe LesL wlll be LreaLed confldenLlally wlLh my
rlghL Lo prlvacy assured.

l release Lhls laboraLory and lLs employees from any llablllLy for any ln[ury or lllness LhaL l may
suffer whlle underLaklng Lhe assessmenL, or subsequenLly occurrlng ln connecLlon wlLh Lhe
assessmenL or LhaL ls Lo any exLenL conLrlbuLed Lo by lL.

l hereby agree LhaL l wlll presenL myself for LesLlng ln a sulLable condlLlon havlng ablded by Lhe
requlremenLs for dleL and acLlvlLy advlsed for me by Lhe flLness LesLlng sLaff.


arLlclpanL's slgnaLure: ...............................

uaLe: ...............................