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Gym & Fitness Liability Waiver

First name

Last name

Email

Date of Birth

Do you have any barriers to exercise (eg. injury, pre/post natal, health condition)? *

No

Yes

If yes, have you been approved by your doctor/physician to exercise? *

No

Yes

Please provide more information on any injuries/reasons you may be modifying

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.

Thanks for submitting!

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