Waiver & Release

Please Fill out the following Electronic Form


While training with Christine Van Diest at either Respiro Box, Push Performance, my home gym or any other fitness center. 

I understand that physical exercise can be strenuous and subject to risk of serious injury, you are urged to obtain a physical examination from a doctor before participating in any exercise activity.  I (Client on electronic form) agree that if I engage in any physical exercise or activity, I do so entirely at my own risk

Any recommendation for changes in diet & nutrition including the use of food supplements and weight reduction products are entirely my responsibility and I should consult a physician prior to undergoing any dietary or food supplement changes.  I agree that I am voluntarily participating in these activities and assume all risks of injury, illness or death.


This waiver and release of liability includes, without limitation, all injuries which may occur as a result of: (a) your participation in any activity or personal training session and (b) instruction, training, supervision, or dietary recommendations by my Personal Trainer, Christine Van Diest.


I acknowledge that I have carefully read this “waiver and release” and fully understand that it is a release of liability.  I expressly agree to release and discharge my Personal Trainer, Christine Van Diest, from any and all claims or causes of action and I agree to voluntarily give up or waive any right that I may otherwise have to bring a legal action against my Trainer, Christine Van Diest, for personal injury or property damage.


To the extent that statute or case law does not prohibit release for negligence, this release is also for negligence on the part of the Personal Trainer, Christine Van Diest.


If any portion of this release from liability shall be deemed by a Court of competent jurisdiction to be invalid, then the remainder of this release from liability shall remain in full force and effect and the offending provision or provisions severed here from.


By submitting this release for electronically I acknowledge that I understand its content and that this release cannot be modified orally.  

If under 18, legal guardian will sign this form.  

Name *