Contact me to get started today!

Please fill out this quick par q and I will be in touch shortly to get you started on the right plan for you!

Gym & Fitness Liability Waiver

First name

Last name

Date of Birth

Has a Dr ever told you not to participate in physical activity?

Yes

Do you have a heart condition or get dizzy/or shortness of breath during physical activity?

Yes

Please state your goals and if you have any limitations. (Or anything I should know)

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.

I will be in contact with you shortly!