digital waivers for fitness centers

PERSONAL TRAINING RELEASE AND WAIVER

AND FITNESS EVALUATION
PLEASE READ THIS JUDICIOUSLY

I, as the name listed below, have registered voluntarily to engage in the Body Wellness Fitness and Management now called (BWFM) Fitness Personal Training and Fitness Evaluation.  I understand that this Fitness EVALUATION is in preparation for personal training exercises with BWFM.  I acknowledge and understand that BWFM has instructed me that I should meet with and discuss my intentions to start an exercise program with my Medical Professional prior to entering and starting any exercise classes or personal training.

I understand and agree that I, alone, am responsible for determining my physical and mental fitness and my suitability to participate. I acknowledge that BWFM will not attempt to determine, nor will I hold BWFM liable to determine my physical and mental fitness, suitability, or capability to participate either before I begin participation or at the time during my participation in any Fitness Activity.   I understand and agree that if I, alone, choose to waive the initial fitness evaluation and/or do not consult with my primary medical physician I am responsible for my decision.

I fully understand that The BWFM evaluation / assessment is only a brief physical evaluation of basic fat ratio, weight, muscle tone, flexibility and the BWFM evaluation / assessment does not replace a full physical evaluation from your medical professional.   I acknowledge that BWFM instructed me to have a full medical evaluation by a medical professional prior to entering into any physical exercise programs.

I release BWFM and all of its affiliated entities, officers, agents, Homeowners Association, Body Wellness Fitness and Management Inc ( BWFM).employees, representatives, directors, and trustees, Independent contractors, H.O.A and I waive any claim that I might make against BWFM and its affiliates entities, officers, agents, employees, representatives, directors, and trustees, for any physical injury or death arising out of or relating to my participation in, or during travel related to, this Fitness Evaluation Activity. I understand and agree that the effect of signing this Release and Waiver of Liability is to give up all of my legal rights to file any lawsuit or to recover any money damages against the Center and its affiliated entities, officers, agents, employees, representatives, directors, and trustees for any claim relating to the Fitness Evaluation / Personal Training including any claim for negligence by BWFM or negligence by any employee of BWFM. Because participation in the Personal Training / Fitness Evaluation is voluntary, I have agreed to sign this Release and Waiver of Liability. I have been given the opportunity to read carefully all of the terms of this Release and Waiver of Liability and I understand fully the legal consequences of signing it. I agree to this because I choose to participate in the Fitness Personal Training/Evaluation at my own risk, knowing that I have no legal right to seek recovery of damages or otherwise to make any claim against BWFM for any harm or injury, including death that I may suffer as a result of my participation.

Client's Full Name: *

Please enter your full name.

*PLEASE INITIAL:

* Please click the yellow area and provide your initials here.

Signature: *

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Date *

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Email: Please enter your email.

EMERGENCY CONTACT #: * Please enter your phone number.

Name of Person: * Please enter your name.

HEALTH HISTORY QUESTIONNAIRE

IMPORTANT: Please take your time to complete each question accurately. This information will be used to help us guide you through the proper avenues in your pursuit of health and well-being. It is recommended that you consult with your physician before beginning an exercise program.

Date *

Please enter valid date.

Name: * Please enter your name.

Address: *

Please enter address.

Phone(H): * Please enter your phone number.

Phone(M): * Please enter your phone number.

Personal Physician(s): * Please enter your answer here.

Address: *

Please enter address.

Phone: * Please enter your phone number.

PERSONAL DATA & STATISTICS

Client's Age * Please enter your answer here.

Client's Date of Birth: *

Please enter valid date.

Client's Sex: * Please select one here.

Client's Height * Please enter your answer here.

Client's Weiht * Please enter your answer here.

Frame: *

Large

Med

Small

Please select at least one choice above.

TODAY’S PERSONAL PROFILE

Occupation: * Please enter your answer here.

How would you rate your health? * Please enter your answer here.

Do you perceive any problem areas within the body? * Please enter your answer here.

Please describe your normal diet? * Please enter your answer here.

What beverages would you say you drink on a regular basis? * Please enter your answer here.

What kinds of foods would you say you consume on a regular basis? * Please enter your answer here.

Do you presently exercise? If yes, what kind of exercise? How often? * Please enter your answer here.

Do you smoke? If yes, how much? * Please enter your answer here.

Do you drink? If yes, how much? * Please enter your answer here.

Do you take vitamins? if yes, Specify: * Please enter your answer here.

Are you presently taking prescription drugs? If yes, Please specify: * Please enter your answer here.

State your interest for engaging in this kind of program: * Please enter your answer here.

Evaluating your own personal profile, what course of action would you recommend to improve your present state of health and well-being? * Please enter your answer here.

GENERAL HEALTH HISTORY

When was the last time you received a comprehensive medical exam? * Please enter your answer here.

Have you had major surgery? If so when, please specify: * Please enter your answer here.

Have you seen a Chiropractor recently? If so specify: * Please enter your answer here.

Was your cholesterol ever taken? If so when and what was the reading? * Please enter your answer here.

Have you ever had high blood pressure? Please specify: * Please enter your answer here.

Have you recently had an illness or an infection? Please specify: * Please enter your answer here.

Have you or any member of your immediate family had a heart condition of any kind? If yes, please specify * Please enter your answer here.

Have you had a history of the following conditions? *

Chronic kidney disease

Acute or chronic liver disease

Moderate to severe liver disease

History of kidney stones

Thyroid condition

Colostomy

Diabetic on insulin

None

Please select at least one choice above.

For the following conditions; you should notify your physician so that he/she is aware that you are making modifications in your lifestyle through diet, nutrition and exercise. *

Hypertension (high blood pressure – taking diuretics or water pills)

Diabetes Mellitus – taking oral hypoglycemic

Taking antidepressant/anxiety

Gout

Nursing mother

None

Please select at least one choice above.

I wish to engage voluntarily in the Personal Training program given by Body Wellness®. I understand that a medical evaluation is recommended for the purpose of detecting any conditions, which would indicate that I should not engage in exercise. I also understand that this medical evaluation is my responsibility.

I reviewed the above responses and they are true to the best of my knowledge, and I wish to engage in The Body Wellness® Personal Training Program.

Signature *

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Please sign here.

Date *

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Name: * Please enter your name.

I, as the name listed above, hereby acknowledge that Body Wellness Fitness and Management Inc, (hereinafter BWFM ) private training sessions held at any Body Wellness ® studio location, or at clients community or country club (hereinafter jointly known as “Programs”) are designed to provide general fitness exercise guidelines by a group or personal fitness (hereinafter “Instructor”).

I understand there are health risks associated with activities in these Programs. The health risks include, but are not limited to, transient dizziness, lightheaded, fainting, nausea, muscle cramping, musculoskeletal injury, joint pains, sprains and strains, heart attack, stroke, or sudden death. If I experience any of these or any other symptoms while exercising, I will discontinue the activity, notify the Instructor, and consult my physician. I am capable of performing physical exercise and acknowledge that I am voluntarily participating in these Programs. I am participating in the Programs with knowledge of the dangers and risks involved. I understand that I am fully responsible for complying with any restrictions prescribed for me by my personal physician and that I agree to consult my personal physician for further evaluation and such medical care as I require. I acknowledge my participation in these Programs is at my sole risk. I have been advised to consult with my personal physician before participation in the Programs. If recommended by my physician, I will consult with him/her on a regular basis. The Instructor and BWFM employees & owners (hereinafter “Team Members”) are not responsible for monitoring my compliance with my physician's recommendations. Even consultation with my regular physician is in no way a guarantee against the possibility of adverse occurrences during these Programs. Nutrition & Dietary Information: Instructors and BWFM Team Members are NOT licensed nutritionists; therefore, I understand, any and all statements made by either of them are solely their personal belief, practice, and/or opinion. I will not take or construe their statements as medical or professional advice. If I have any questions about my nutrition or diet, then I will ask my physician or seek a licensed nutritionist for their professional recommendation. Personal Property: BWFM is not responsible for any lost or stolen items. Personal property or valuables left anywhere on BWFM premises or at community premises are at my own risk and is never under the care or watch of a BWFM Team Member or Instructor. In consideration for my participation in these Programs I, my family, heirs, executors, representatives, administrators, waive, release, and forever discharge Body Wellness ® respective owners, shareholders, employees, Instructors, H.O.A. and Independent Contractors from any and all responsibilities, liabilities and lawsuits, present or future, and causes of action for ordinary negligence, whether foreseeable or unforeseeable, arising out of or related in any manner directly or indirectly, to my use of or access to the Body Wellness ® premises or community premises and my participation in their Programs. This waiver includes, but is not limited to such claims that may result from any injury, illness, or death, accidental or otherwise, during or arising in any way from my participation in any exercise or recreation activity or fitness testing associated with the Programs. I hereby agree to expressly assume and accept sole responsibility for the risk of injury or death by Body Wellness ® and/or my Instructor.

Package Expiration/Refund Policy
Individuals registering for personal training must complete all personal training sessions by the end of the client’s eligibility to participate in the program or by the expiration date of the training package, whichever comes first. All packages are non-refundable/non-transferable.

Please select one: *

I consent to be photographed and to allow Body Wellness ® to use photos taken of me and/or my minor children for promotional purposes.

I do not consent to be photographed and to allow Body Wellness ® to use photos taken of me for promotional purposes.

Please select at least one choice above.

This Release and any dispute arising under or related to it will governed and interpreted to the laws of the State of Florida, without regard to its conflicts of law rules, and venue for any such actions shall be in Palm Beach County, Florida.
With my signature, I certify that I have read the above, had all questions answered to my satisfaction, understand, and agree to the terms of the Exercise Waiver & Liability Release:

Community Name: * Please enter your name.

Fitness Class Name: * Please enter your name.

Class Time: * Please enter your answer here.

Phone #: * Please enter your phone number.

Email: * Please enter your email.

Date *

Please enter valid date.

Client Signature: *

Click to sign

Please sign here.

Body Wellness® Fitness & Management Inc
Credit Card Authorization Form
COMPLETE THIS AUTHORIZATION AND RETURN TO US

Please select one: *

I authorize Body Wellness® to charge the below credit card for services provided herein. I also agree that Body Wellness® may use this credit Card on file for any other future charges. I agree that I will pay for this purchase in accordance with the issuing bank cardholder agreement.

Community Paying Event

I have made other arrangements with Body Wellness®

I have already paid.

Please select at least one choice above.

Agree to sign the digital waivers for fitness centers, owing to participation in the personal training voluntarily.