Sports Physical Form

  • Information on the Individual receiving the Sports Physical
  • Parent or Guardian Information
  • Date Format: MM slash DD slash YYYY
  • :
  • Release of Liability

    By signing this form I understand that my participation in this class may involve activities that are designed to increase physical activity and may also include fitness and conditioning. I understand a photograph of me in a fitness class might be used for promotional purposes. As with any physical activity or lifestyle changes I understand that Heritage Victor Valley Medical Group has recommended that I consult with my personal health care provider if I have been diagnosed with any major illness or am on medications that may be affected by lifestyle changes prior to participation in the class. In consideration for my participation in the class, I do hereby and forever discharge Heritage Victor Valley Medical Group (HVVMG) and its employees, jointly and severally, from any and all actions, causes of actions, claims and demands for, upon, or by any reason of damage, loss of property or injury which hereafter may be sustained by participating in the class. If I am a minor, I agree to sign and have a parent or legal guardian sign this form.

    In consideration for my participation in the class, I do hereby and forever discharge Heritage Victor Valley Medical Group (HVVMG) and its employees, jointly and severally, from any and all actions, causes of actions, claims and demands for, upon, or by any reason of damage, loss or injury which hereafter may be sustained by participating in the class. If I am a minor, I agree to sign and have a parent or legal guardian sign this form.