METAFit LLC New Client Form

Full name*

First NameLast Name

Birth Date*

MonthDayYear

E-mail*

example@example.com

Phone Number*

Emergency contact*

First NameLast Name

Phone number*

Which service will you be participating in?

Please read the questions carefully and answer each one honestly: check YES or NO.

Par-Q*

	Yes	No
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
n the past month, have you had chest pain when you were not doing physical activity?
Do you lose balance because of dizziness or do you ever lose consciousness?
Is your doctor currently prescribing drugs (for example water pills) for your blood pressure or heart condition?
Are you currently pregnant?
Do you have diabetes or thyroid condition?
Do you know of any other reason why you should not engage in physical activity?
Do you plan to become pregnant in the next 3 months?
Do you have bone or joint problem (for example, back, knee, or hip) that could be worsen by a change in your physical activity?

If you answered Yes to any questions 1-8 above, A MEDICAL CLEARANCE FORM IS REQIRED of all participants prior to beginning training. If YES to any, physical and aerobic fitness activities CANNOT be administered. NOTE: Coaching staff reserve the right to require medical clearance from any client they feel may be at risk. Discuss with your personal doctor any connditions that may affect your exercise program. All precautions must be documented on the medical clearance form by your personal doctor.

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If you answered Yes to any questions 9 or 10, METAFit LLC requests written permission from your physician before you may participate in physical and aerobic fitness activities. If you choose not to get written permission, you must acknowledge by signing below that METAFit LLC has asked you to visit your physician to obtain medical release before beginning an exercise program. You have elected not to do so and assume the risk for any injuries arising from undertaking any and all exercise due to a known or unknown medical condition

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If you answered NO to all questions above, you have provided to METAFit LLC a general indication that you may participate in physical and aerobic fitness activities and/or fitness evaluation testing. The face that you answered NO to the above questions is no guarantee that you will have a normal response to exercise or that a fitness regimen will not cause you medical problems

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In consideration of being allowed to participate in the activities and programs offered by METAFit, LLC, and to use its programs and training, in addition to the payment of any fee or charge, I do hereby waive, release and forever discharge and hold harmless METAFit, LLC and its consultants, officers, agents, and employees from any and all responsibility, liability, cost, and expenses, including injuries or damages, resulting from my participation in any activities, or my use of any programs designed by METAFit, LLC. I do also hereby release METAFit, LLC and its consultants, officers, agents, and employees from any responsibility or liability for any injury, damage, or disorder (physical, metabolic, or otherwise) to myself, or in any way arising out of or connected with my participation in any activities with METAFit.

I understand and am aware that strength, flexibility, and aerobic exercise, including the use of equipment are potentially hazardous activities. I also understand that fitness activities involve a risk of injury and even death and that 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 or death related to said fitness activities. In addition, I certify that I am 18 years of age or older or signing as the parent/guardian of an athlete that is 7 years of age or older.

I do hereby further declare myself to be physically sound and suffering from no condition, impairment, disease, infirmity, or other illness that would affect nutrient metabolism or prevent my participation or use of equipment or machinery except as hereinafter stated.

I do hereby acknowledge that METAFit, LLC has recommended to me that I obtain a physician’s approval for my participation in an exercise/fitness activity or in the use of exercise equipment and machinery.

I also acknowledge that METAFit, LLC has 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/ her recommendations concerning these fitness activities and equipment use.

I acknowledge that I have either had a physical examination and been given my physician’s permission to participate, or that I have decided to participate in the activity and use of equipment, machinery, and programs designed by METAFit, LLC without the approval of my physician and do hereby assume all responsibility for my participation and activities, and utilization of equipment and machinery in my activities.

METAFit diet/training programs are not meant to treat or manage any health condition. Always consult with your healthcare provider prior to adjusting your current style of eating or beginning any new diet and/or training plan. In addition, I hereby represent and warrant that I am currently covered by an accident and health insurance policy.

I understand that by purchasing any of METAFit Training Programs and Services, I am bound to this entire agreement.

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Do we have your consent to post any photos or videos of training sessions for further promotion, social media marketing and athlete exposure?

YesNo

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Date

Type Date

Member Information

Health Questionnaire (Par-Q)

Agreement & Release of Liability

Social Media Consent