PreScreen Questionnaire and Waiver

Full Name

Phone *

Email *

What is the #1 Result you are looking for? *

Why do you want achieve these goals? eg. Feel better, look better, live longer.. etc *

Have you trained before? *

Yes

No

How often are you planning to train a week?

2-3 Times

4+ Times

Do you have any pre existing health conditions that may impact your training?

Yes

No

If yes. Please provide more information about your pre existing health conditions.

Do you have any pre existing or current injuries that may affect your training? eg. back, knee

Yes

No

Please provide more information about your pre existing or current injuries

Are you clear to exercise from your injuries or being post partum?

Yes

No

I agree to the terms and conditions of your training facility. By participating in the workouts, I hereby assume the risks of any injuries that I may sustain on the premises. I hereby remise, release and forever discharge your facility from any liability, responsibility or actions suits, damages claims or judgements that may results from any personal injury or even death I may sustain while on the premise, as a result of my participate in the workout during my trial or membership term. *

Yes

No

Date

Guardian Name (If participants under age of 18)

Signature Panel (must be 18+) *

Clear