TOM POLLARD'S PERSONAL TRAINING 
AKA DR PLANKENSTEIN!
NSCA CERTIFIED PERSONAL TRAINER
SERVICING PASCO AND HILLSBOROUGH COUNTIES.


                Tom Pollard NSCA CPT Waiver.

Answer Yes or NO to the following questions.

  1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
  2. Do you feel pain in your chest when you do physical activity?
  3. In the past month, have you had chest pain when you were not doing physical activity?
  4. Do you lose your balance because of dizziness or do you ever lose consciousness?
  5. Do you have a bone or joint problem that could be made worse by a change in your physical activity?
  6. Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?
  7. Do you know of any other reason why you should not do physical activity?

If you answered yes to any of the above questions, Thomas Pollard the personal trainer recommends consulting with a physician before partaking in a bootcamp session or any other exercise program so that specific guidelines can be met. If you answered No to all the questions please read the following paragraph before signing.

Waiver - By signing this form below, I certify that I am physically able to participate in the bootcamp exercise class and do hereby agree that this program is not responsible or liable to me for any injury, accident or loss of personal property.  I do hereby release Thomas Pollard from any claim or cause of action which may have occurred as a result of any medical problem known or unknown which I may have knowledge presently or in the future.  I verify no promise or guarantees, other than those written in this agreement, was made to me by this program or its employees.  I agree to follow Thomas Pollard’s instructional guidelines and to cooperatively utilize the program with other participants.  I understand that I am working out at my own risk and understand the program has No Liability Insurance for any public places the classes are held. I CERTIFY THAT I HAVE READ THIS AGREEMENT AND AGREE TO THE TERMS HEREIN

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