Virtual Exercise Group

Consent/Release and Waiver

Virtual Exercise Group

Consent/Release and Waiver of Liability Form


I, hereby acknowledge my consent to take part in virtual exercise classes offered by the Paperny Family JCC. A certified instructor will be facilitating the exercise program and I am aware that I can speak with, or message the instructor if I have concerns during these sessions.

I will adhere to the following recommendations:

  • That I can only participate if I have a camera on my electronic device allowing JCC instructors to observe me at all times while performing the exercises. This will allow them to ensure that I am doing the exercises safely and will allow them to respond appropriately in case of an emergency;
  • That I will inform JCC staff of my departure should I have to leave the session early;
  • That I have a phone in proximity in case of an emergency;
  • That I will use a sturdy chair (without wheels), wear proper footwear and will have a water bottle/glass of water near me to stay hydrated;
  • That I will be exercising in a space which is free and clear from obstacles which might pose a risk for falls.
  • That I am physically ready to participate in the Zoom virtual exercise session.


I understand that Zoom’s virtual platform has limitations compared with in-person encounters, for example, difficulty for the instructor to properly observe participants’ positioning as they perform their exercises.

I understand that I am responsible for my wellbeing, and that I may modify and/or refrain from certain exercises, and can stop doing the supervised virtual exercise session at any time, provided I inform the JCC instructor responsible for the session if I choose to leave.

There are risks involved in any exercise program, which could include, but are not limited to, the following: episodes of transient lightheadedness, abnormal heart rate and/or blood pressure, chest discomfort, leg cramps, nausea, loss of consciousness, and that I voluntarily and willfully assume those risks.

I understand that it is my obligation to immediately inform the instructor responsible for the virtual Zoom session of any pain, discomfort, fatigue, difficulty breathing, discomfort in chest, shoulder, jaw, back, neck or any other health symptoms that I may have during or following the virtual exercise class.

I further understand that if I observe, feel, or have any symptoms of undue distress, an abnormal response (chest pain, difficulty breathing), or that I think that I am having a stroke or heart attack, I will call 911 immediately.

I agree that by participating in the Zoom virtual exercise session, I do so entirely at my own risk, and I voluntarily and willingly assume all risks of injury, illness, or death. By signing the waiver, I acknowledge that I have carefully read this VIRTUAL EXERCISE GROUP INFORMED CONSENT/RELEASE AND WAIVER OF LIABILITY FORM and fully understand that it is a release of liability. I agree to release the instructors, the JCC, and all of its directors, officers, employees and agents of and from any and all complaints, claims, demands or causes of action and agree to waive any right that I may otherwise have to bring legal action against any JCC employee.

I have read, understand, and agree to the terms expressed in this document.


Virtual Exercise Group

Consent / Release and Waiver of Liability

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