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Email
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Phone
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Emergency Contact
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Emergency Contact Phone
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Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
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Yes
No
Do you feel fain in your chest when you do physical activity?
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Yes
No
In the past month, have you had chest pain when you were not doing physical activity?
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Yes
No
Do you lose balance because of dizziness or do you ever lose consciousness?
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Yes
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Do you have bone or joint problem (for example, back, knee, or hip) that could be worsen by a change in your physical activity?
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Yes
No
Is your doctor currently prescribing drugs (for example water pills) for your blood pressure or heart condition?
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Yes
No
Do you know of any other reason why you should not do physical activity?
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This agreement releases Whitney Williams and Staff from all liability relating to injuries that may occur during personal training or group exercise classes. By signing this agreement, I agree to hold Whitney Williams and Staff entirely free from any liability, including financial responsibility for injuries incurred, regardless of whether injuries are caused by negligence. I also acknowledge the risks involved in personal training and group exercise classes. Agreeing that engaging in any physical exercise or activity, including personal training, using any facility or equipment for any purpose, I do so at my own risk and assume the risk of any and all injury and/or damage I may suffer, whether while engaging in physical exercise or not. I swear that I am participating voluntarily, and that all risks have been made clear to me. Additionally, I do not have any conditions that will increase my likelihood of experiencing injuries while engaging in this activity. By signing below I forfeit all right to bring a suit against Whitney Williams and Staff for any reason. In return, I will receive participation in training and classes. I will also make every effort to obey safety precautions as listed in writing and as explained to me verbally. I will ask for clarification when needed.
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Yes, I fully understand and agree to the above terms.
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About
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