Release for Walking Sessions 



To be completed by all clients wishing to participate in walking sessions or other sessions involving exercise.

Release of Liability:
I waive, release and forever discharge Spencer Psychology and its staff from any and all responsibility and/or liability for any injuries or damages resulting from participation in walking counseling sessions. I accept any risk associated with exercise and voluntarily participate in these sessions.

Health Status Affirmation:
I declare myself to be physically sound and suffering from no condition, impairment or infirmity that would prevent my participation. I acknowledge that I have been told to ask my doctor if walking for at least 45-60 minutes and possibly longer, without a break is acceptable for my health status.


I hereby state that I have read and fully understand the above statements as they apply to me. I voluntarily authorize this consent. A fax or copy is the same as the original.

Signature     Date