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Fitness Consent Form

Birthday
Day
Month
Year
What are your fitness goals?
Medical Conditions - Please mark all that apply
Has your doctor ever told you that you have a heart condition or have you ever suffered a stroke or that you should only do exercise recommended by a doctor?
Do you ever suffer from pains in your chest at rest or during physical activity/exercise?
Yes
No
Do you smoke?
Yes
No
How did you hear about this class

I have enrolled in a fitness/exercise program of strenuous physical activity which may include but is not limited to aerobic conditioning and cardiovascular conditioning, weight training, strength training and flexibility training offered by Stephen Gammack via an online feed.


In consideration of my participation in this fitness/exercise program, I hereby release Stephen Gammack or any persons involved with the fitness/exercise program, from any claims, demands and causes of action arising from my participation in the fitness/exercise program.


I fully understand that I may injure myself as a result of my participation in the fitness/exercise program and I do hereby release Stephen Gammack from any liability now or in the future including but not limited to heart attacks, muscle strains, pulls or tears, broken bones, shin splints, heat prostration, knee/back/foot injuries and any other illness, soreness or injury caused, occurring, during or after my participation in the fitness/exercise program.


I hereby affirm that by ticking the box below I have read, understand and agree to the above. I recognise that it is my responsibility to discuss any exercise programme with a physician/doctor prior to taking part and that by ticking this box I acknowledge that I participate in this exercise program at my own risk.

Waiver
I agree to to the terms and conditions
I do not agree to the terms and conditions
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