I, , have enrolled in a program of strenuous physical activity including but not limited to all exercise programs, classes and conditioning offered by Nicole Brewer. I, hereby affirm that I am in good physical condition and do not suffer from any disability which would prevent or limit my participation in this exercise program.

In consideration of my participation in Nicole Brewer's exercise program,

I, , for myself, my heirs and assigns, hereby release Nicole Brewer from any claims, demands and causes of action arising from my participation in the exercise program.

I fully understand that I may injure myself as a result of my participation in Nicole Brewer's exercise program and I, , hereby release Nicole Brewer from any liability now or in the future including, but not limited to heart attacks, muscle strains, pulls or tears, broken bones, shin sprints, heat prostration, knee/lower back/foot injuries, drowning, and any other illness, soreness or injury however caused, occurring during, or after my participation in the exercise program.

Signature:
Date:

I hereby affirm that I have read and fully understand the above.