Find the best fitness registration form template on the WaiverElectronic website.

Please complete the Waiver for Bodhi Aesthetics.

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Please fill your name: *

Please enter your full name.

Date of Birth: *

Please enter valid date.

Phone number: * Please enter your phone number.

Please fill in Address: *

Please enter address.

HEALTH ASSESSMENT

Have you ever had any form of heart disease? *

Yes

No

Please select at least one choice above.

Have you ever-experienced shortness of breath or chest pains? *

Yes

No

Please select at least one choice above.

Do you have or do any of the following pertain to your heath?

High Blood Pressure? *

Yes

No

Please select at least one choice above.

Cigarette Smoking? *

Yes

No

Please select at least one choice above.

Diabetes? *

Yes

No

Please select at least one choice above.

Family History of Heart Disease? *

Yes

No

Please select at least one choice above.

Do you work out at least three times per week? *

Yes

No

Please select at least one choice above.

Are you currently taking any medication? *

Yes

No

Please select at least one choice above.

Do you have any problems in the following areas?

Knees? *

Yes

No

Please select at least one choice above.

Lower Back? *

Yes

No

Please select at least one choice above.

Neck/Shoulders? *

Yes

No

Please select at least one choice above.

Hip/Pelvis? *

Yes

No

Please select at least one choice above.

Is there any other reason you know of that you should not participate in exercise?

No

Please select at least one choice above.

INFORMED CONSENT/ASSUMPTION OF RISK:

I agree to participate in one or more physical fitness programmes/classes sponsored by BODHI AESTHETICS, which may include, but not necessarily be limited to, cardiovascular training, weightlifting, and/or training of any kind by any affiliate, subsidiary or partnership of BODHI AESTHETICS and/or CONOR MORRISON (hereinafter collectively referred to as BODHI AESTHETICS). BODHI AESTHETICS made me fully aware that the fitness programmes, which BODHI AESTHETICS offers and in which I desire to participate, are of a nature and kind that are extremely strenuous and can/may push me to the limits of my physical abilities. I the undersigned recognize and understand that the programmes/classes are not without varying degrees of risk, which may include, but are not limited to the following:

Injury to the musculoskeletal and/or cardio respiratory systems which can result in serious injury or death, injury or death due to negligence on the part of myself, my training partner, or other people around me, injury or death due to improper use or failure of equipment, or injury or death due to a medical condition, whether known or unknown by me. I am aware that any of these above-mentioned risks may result in serious injury or death to myself and or my partner(s).

Initial Here

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

I willingly assume full responsibility for any and all risks that I am exposing myself to as a result of my participation in BODHI AESTHETICS programmes and accept full responsibility for any injury or death that may result from participation in any activity, class or physical fitness programme.

I herby certify that I know of no medical problems that would increase my risk of illness and injury as a result of participation in a fitness programme designed by BODHI AESTHETICS. BODHI AESTHETICS informed me that there exists the possibility of adverse physical changes during an exercise programme, and I fully understand the same. BODHI AESTHETICS informed me that these changes could include abnormal blood pressure, fainting, disorder of heart rhythm, stroke, and in very rare instances, heart attack or even death, and I fully understand the same. With my full understanding of the above information, I agree to assume any and all risk associated with my participation in BODHI AESTHETICS fitness programmes.

Initial Here

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

RELEASE:

In full consideration of the above mentioned risks and hazards and in full consideration of the fact that I am willingly and voluntarily participating in the activities made available by BODHI AESTHETICS, and with my full understanding of all of the above, I hereby waive, release, remise and discharge BODHI AESTHETICS and its agents, officers, principals and employees and volunteers, of any and all liability, claims, demands, actions or rights of action, or damages of any kind related to, arising from, or in any way connected with, my participation in BODHI AESTHETICS fitness programmes/classes, including those allegedly attributed to the negligent acts or omissions of the above mentioned parties.

This agreement shall be binding upon me, my successors, representatives, heirs, executors, assigns, or transferees. If any portion of this agreement is held invalid, I agree that the remainder of the agreement shall remain in full legal force and effect.

If I am signing on behalf of a minor child, I also give full permission for any person connected with BODHI AESTHETICS to administer first aid deemed necessary, and in case of serious illness or injury, I give permission to call for medical and or surgical care for the child and to transport the child to a medical facility deemed necessary for the well-being of the child.

Initial Here

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

INDEMNIFICATION:

I recognize that there is risk involved in the types of activities offered by BODHI AESTHETICS. Therefore I accept financial responsibility for any injury that I or the participant may cause either to him/herself or to any other participant due to his/her negligence. Should the above-mentioned parties, or anyone acting on their behalf, be required to incur attorney’s fees and costs to enforce this agreement, I agree to reimburse them for such fees and costs. I further agree to indemnify and hold harmless BODHI AESTHETICS, their principals, agents, employees, and volunteers from liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in activities offered by BODHI AESTHETICS.

Initial Here

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

USE OF PICTURE(S)/FILM/LIKENESS:

I agree to allow BODHI AESTHETICS, its agents, officers, principals, employees and volunteers to use picture(s), film, and/or likeness of me for advertising purposes. In the event I choose not to allow the use of the same for said purpose, I agree that I must inform BODHI AESTHETICS of this in writing.

Initial Here

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

I have fully read and fully understand the foregoing assumption of risk, and release of liability and I understand that by signing it, obligates me to indemnify the parties named for any liability for injury or death of any person and damage to property caused by my negligent or intentional act or omission. I understand that by signing this form I am waiving valuable legal rights.

Your Signature *

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