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Last Name

WEIGHT *WEIGHT

DOB *DOB

Email Address *

Phone *

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

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What grade will you be entering in the fall?

What sports/recreation do you participate in, if any?What sports/recreation do you participate in, if any?

How did you hear about us? If by REFERRAL please provide name:

What's your fitness goal?

What's your favorite hobby, Activity, Community Action?

What's your personal goal?

PHYSICAL ACTIVITY READINESS QUESTIONNAIRE

How serious are you about achieving your goals?

I AGREE AND HEREBY ACKNOWLEDGE THE FOLLOWING WAIVER AND RELEASE FORM. *YESBecause physical exercise can be strenuous and subject to risk of serious injury, we urge you to obtain a physical examination from a doctor before using any exercise equipment or participating in any exer- cise activity. You agree that by participating in physical exercise or training activities, you do so entirely at your own risk. Any recommendation for changes in diet including the use of food supplements, weight reduction and/or body building enhancement products are entirely your responsibility and you should consult a physician prior to undergoing any dietary or food supplement changes. You agree that you are voluntarily participating in these activities and use of these facilities and premises and assume all risks of injury, illness, or death. We are also not responsible for any loss of your personal property. You acknowledge that you have carefully read this “waiver and release” and fully understand that it is a release of liability. You expressly agree to release and discharge the trainer or instructor from any and all claims or causes of action and you agree to voluntarily give up or waive any right that you may other- wise have to bring a legal action against the trainer or instructor for personal injury or property damage. To the extent that statute or case law does not prohibit releases for negligence, this release is also for negligence. You agree to allow video and photo documentation of the progress between the athlete and trainer sessions. 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 signing this release, I acknowledge that I understand its content and that this release cannot be modified orally.

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