Health Questionnaire and Liability Waiver

Please fill out the following form to acknowledge you are fit to participate in physical activity. All physical activity is done so at your own risk.

First Name

Email Address

Last Name

Date of Birth

Are you currently suffering from a medical condition, illness, or injury that would prevent you from safely participating in this activity? If Yes, please consult your doctor before participating in physical actvity

Yes

Have you been told by your doctor not to participate in physical activity?

Yes

Initials

Today's Date

I declare that the info I’ve provided is accurate & complete. By submitting this form I acknowledge that I am physically able to participate in this activity. I understand the risk of physical activity and am responsible for my own safety. Should I injure myself while participating in this class, the instructor will not be held responsible or liable. By clicking here I am releasing the instructor of all liability, including negligence.

Thanks for submitting!