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Training Registration & Health History Form

Please fill out the following form.

Please check all that apply:
Please check all that apply
Have you ever experienced by of the following symptoms:
Are you currently or have you recently experienced any of the following?

In providing the health-related information contained in this form, I understand its use is intended for fitness testing and fitness programming and is not a medical screening which should be provided by my physician.  I acknowledge, to the best of my ability, that I have answered the above questions completely and honestly and reaffirm that I have no known medical problems that would restrict my ability to participate in this exercise program.  I also understand that any physical activity involves risks.  Therefore, I do hereby waive, release, and forever discharge the Trainer from any or all responsibilities or liability from injuries or damages occurring as a result of my participation in any activities or use of equipment or machinery.

That I am utilizing the JS Fitness and Wellness Studio and may be participating in the health and fitness classes, programs or workshops offered by JS Fitness and Wellness during which I receive information and instruction about health and fitness. I recognize that fitness programs require physical exertion which may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved.

That it is my responsibility to consult with a physician prior to and regarding my participation in the health and fitness classes, programs, workshops or utilizing the facility on my own. I represent and warrant that I am physically fit and have no medical condition which would prevent me from exercising on my own or participating in the exercise classes, health programs or workshops.

 

That in consideration of being permitted to utilize the facility on my own or participating in the health and fitness classes, programs or workshops in the facility or in the common areas of the building serving the facility, I agree to assume full responsibility for participating in the program or utilizing the facility on my own.

 

That in consideration of being permitted to utilize the facility on my own or participating in the health and fitness classes, programs or workshops in the facility or in the common areas of the building serving the facility, I knowingly, voluntarily and expressly waive any claim I any have against JS Fitness and Wellness, Spurgeon Inc, Jeff Spurgeon, for any injury or damages that I may sustain as a result of participating in the program or utilizing the facility or any common area on my own. 

 

That I, my heirs or legal representatives forever release, waive, discharge and covenant not to sue JS Fitness and Wellness. Spurgeon Inc., Jeff Spurgeon, for any injury or death caused by their negligence or other acts.

PERSONAL TRAINING POLICIES AND PROCEDURE:

Personal Training sessions are non-refundable and non-transferable.

A 24-hour advanced notice of cancellation or postponement is required for all sessions.  Notice of less than 24 hours will incur full payment of the session fee.  When possible, if Jeff’s schedule allows, he will try to find another time for your session but can’t guarantee this as an option.

If the client is late the Session/Class, it cannot be extended and will end at the appointed time.

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