K3 New Client Profile 2025

K3 Client Profile

and Release of Liability Waiver
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*

Confirmation EmailConfirm Email
Phone Number*
CellHomeWork
Birthday*
Month and Day, example: June 26
Weight lossLowering Blood Pressure and CholesterolShaping & ToningEnergy/EnduranceStress ReductionWeight GainBuilding MuscleBuilding StrengthOverall HealthTraining 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
Oct. 27 - Dec. 5, 2025
Two Day PlanThree Day Plan
Monday 6:00 am - 6:45 am BootcampMonday 5:30 pm - 6:15 pm Bootcamp
Wednesday 6:00 am - 6:45 am BootcampWednesday 5:30 pm - 6:15 pm Bootcamp
Friday 6:00 am - 6:45 am Bootcamp
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 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 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.
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My Products

3 Day Annual Investment Plan

126 klasses

$600.00

2 Day Annual Investment Plan

84 klasses

$300.00

Quarterly 3 Day Investment Plan

54 klasses Jan. 6 - May 19, 2025

$280.00 Quantity

Quarterly 3 Day Investment Plan

54 klasses Jun. 2 - Oct. 17, 2025

$280.00 Quantity

Quarterly 2 Day Investment Plan

36 klasses Jan. 6 - May 19, 2025

$160.00 Quantity

Quarterly 2 Day Investment Plan

36 klasses Jun. 2 - Oct. 17, 2925

$160.00 Quantity

3 Day Investment Plan

18 klasses

$100.00 Number of 6 Week Sessions
Item subtotal:$0.00

2 Day Investment Plan

12 klasses

$60.00 Number of 6 Week Sessions
Item subtotal:$0.00

2 Day Investment Plan - Chair

12 Klasses

$50.00 Quantity

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Total

$0.00

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K3 Client Profile

Work-out Plan

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