Describe your current exercise routine:
What are your fitness goals:
Please indicate any additional medical information that you think is
important for us to know prior to fitness testing and exercise. Example: knee or back problems:
How did you hear about LiveWire Fitness?:
Questions/Comments:
Waiver of Liability and Informed Consent:
I agree to the following:
I am participating in the fitness programs offered by LiveWire Fitness and recognize this requires physical exertion, which may be strenuous and may cause physical injury. I am fully aware of the risks involved.
I represent and warrant that I am physically fit and have no medical condition which would prevent my full participation in the fitness programs. I understand it is my responsibility to consult with a physician prior to and regarding my participation in fitness programs.
I agree to assume full responsibility for any risks, injuries, or damages, known or unknown, which might occur as a result of participating in the fitness program.
I hereby execute and deliver this waiver releasing LiveWire Fitness from and against all claims, costs, liabilities, expenses, and judgment, including attorney's fees and court costs arising of my participation in the program, or any illness or injury while participating in the program. I hereby release any claim I may have against LiveWire Fitness for any injury or death caused by their negligence or other acts.
I, my heirs or legal representatives forever release, waive, discharge, and covenant not to sue LiveWire Fitness for any injury or death caused by their negligence or other acts.
I give LiveWire Fitness full consent to capture pictures/images of my likeness during my participation in LiveWire Fitness classes without requiring remuneration for the same. I agree to release any and all images of this nature to LiveWire Fitness and agree to their usage by LiveWire Fitness in their promotions and on the LiveWire Fitness website.
I have read the above informed consent and waiver of liability and fully understand its contents.
I hereby affirm that I am over 18, and I voluntarily agree to the terms and conditions stated above.