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Health Declaration
Please fill out the following form
in order to participate in our activity.
First name
Last name
Email
Date of Birth
Have you been hospitalized in the last 12 months?
No
Yes
Are you suffering from a medical condition, illness, or injury?
No
Yes
If you answered yes to any question, please elaborate
Initials
I declare that the info I’ve provided is accurate & complete
Submit
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Gym & Fitness Liability Waiver
First name
Last name
Email
Date of Birth
Do you have a doctor’s permit to participate in intense physical activities?
No
Yes
Please specify anything we should know about
Initials
I declare that the info I’ve provided is accurate & complete
I hereby acknowledge this release from liability for accidental injury or illness which I may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.
Submit
Thanks for submitting!
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