K3 Client Profile
and Release of Liability Waiver
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
Confirmation Email
Confirm Email
Phone Number
*
Format: (000) 000-0000.
Phone Type
*
Cell
Home
Work
Birthday
*
Month and Day, example: June 26
Main Goal for Exercising
*
Weight loss
Lowering Blood Pressure and Cholesterol
Shaping & Toning
Energy/Endurance
Stress Reduction
Weight Gain
Building Muscle
Building Strength
Overall Health
Training for an Event (race, etc.)
Work-out Plan
Please select the Plan and the Days and Times you would like to schedule your work-out sessions
2024 Session Dates
October 28 - December 13
PLAN SELECTION
Two Day Plan
Three Day Plan
Monday
Monday 6:00 am - 6:45 am Bootcamp
Monday 5:30 pm - 6:15 pm Bootcamp
Wednesday
Wednesday 6:00 am - 6:45 am Bootcamp
Wednesday 5:30 pm - 6:15 pm Bootcamp
Friday
Friday 6:00 am - 6:45 am Bootcamp
I understand and agree to the following:
*
In consideration of being allowed to participate in the activities and programs of K3- Kicks, Kooks & Koinonia, L.L.C. and to its facilities, equipment, machinery, in addition to the payment of any fee or charge, I do hereby waive, release, and forever discharge K3-Kick, Kooks & Koinonia, L.L.C. and its directors, officers, agents, employees, representatives, successors and assigns administrators, executors, and all others from any and all responsibilities or liability from injuries or damages resulting from my participation in any activities or my use of equipment or machinery in the above mentioned activities. I do hereby release all of those mentioned or others acting upon their behalf from any responsibility or liability for any injury or damage to myself, including those caused by the negligent act or omission of any of those mentioned or others acting on their behalf or in any way arising out of or connected with my participation in any activities or the use of any equipment.
I understand and agree to the following:
*
I understand and am aware that strength, flexibility, and aerobic activity, including the use of equipment, is a potentially hazardous activity. I also understand that fitness activities involve the risk of injury and even death, and I am voluntarily participating in these activities and using equipment and machinery with knowledge of the dangers involved. I hereby agree to expressly assume and accept any and all risks of injury and death.
I understand and agree to the following:
*
I do hereby further declare myself to be physically sound and suffering from no condition, impairment, disease, infirmity, or other illness that would prevent my participation or use of equipment or machinery except as hereinafter stated. I do hereby acknowledge that it has been recommended that I have a yearly or more frequent physical examination and consultation with my physician as to physical activity, exercise, and use of exercise and training equipment so that I might have his recommendations concerning these fitness activities and equipment use. I acknowledge that I have either had a physical examination and have been given my physicians permission to participate, or that I have decided to participate in an activity and use of equipment and machinery without the approval of my physician do hereby assume all responsibility for my participation and activities, and utilization of equipment and machinery in my activities.
By typing your name below, you agree that you have read, answered honestly, and agree to all above information. Failure to sign this waiver will result in non-participation.
*
Typed name is considered an electronic signature for the sake of this waiver.
Signature
*
Please sign your name with your mouse.
Please verify that you are human
*
My Products
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3 Day Plan
18 Sessions
$
100.00
Number of 6 Week Sessions
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$
0.00
2 Day Plan
12 Sessions
$
60.00
Number of 6 Week Sessions
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$
0.00
3 Day Special Holiday Plan
6 Sessions
$
30.00
Quantity
1
2
3
4
5
6
7
8
9
10
2 Day Special Holiday Plan
4 Sessions
$
20.00
Quantity
1
2
3
4
5
6
7
8
9
10
Annual Payment
3 Day Plan
$
600.00
Annual Payment
2 Day Plan
$
300.00
Credit Card
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