The Resistance Gym -Waiver & Health Information
3442 Clayton Road, Concord, CA 94519 (925)338-1731
Name
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First Name
Last Name
Email
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example@example.com
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Please enter a valid phone number.
Birthdate
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Pronoun/s
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Emergency Contact
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First Name
Last Name
Emergency Contact Phone Number
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Please enter a valid phone number.
Health Questions
Do you smoke?
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Yes
No
Do you drink alcohol?
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Yes
No
Are you taking any prescription medication?
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Yes
No
Do you currently exercise?
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Yes
No
How much exercise per week?
Do you play sports?
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Yes
No
Do you have any of these conditions?
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Back, knee or shouldler pain
Previous injuries or surgery
High blood pressure
Heart condition
Diabetes
Asthma
Other
Please provide more details for "other" or if there is anything else we should know.
I agree to respect others pronouns and boundaries. I will not comment on or place moral judgment on my or others' bodies. I will refrain from mentioning my body weight or "goal weight", if applicable. I will not suggest dieting or speak about my personal diet choices.
Photography/Video Release
Participants involved in any activities offered by The Resistance Gym may be photographed or videotaped during training. The undersigned hereby consents to the use of these photographs and/or videos without compensation, on the The Resistance Gym website or in any editorial, promotional or advertising material produced and/or published by The Resistance Gym.
Do you understand and agree?
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I understand and agree
I do not want to appear in video or photograph (remind staff if asked)
Waiver and Release of Liability
Express assumption of risk: I, the undersigned, am aware that there are significant risks involved in all aspects of physical training. These risks include, but are not limited to: falls 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; strains and sprains. I am aware that any of these above mentioned risks may result in serious injury or death to myself and or my partner(s). I willingly assume full responsibility for the risks that I am exposing myself to and accept full responsibility for any injury or death that may result from participation in any activity or class while at, or under direction of The Resistance Gym. I acknowledge that I have no physical impairments, injuries, or illnesses that will endanger me or others.
Do you understand and agree?
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I understand and agree
Release
In consideration of the above mentioned risks and hazards and in consideration of the fact that I am willingly and voluntarily participating in the activities offered by The Resistance Gym, I, the undersigned hereby release The Resistance Gym, their principals, agents, employees, and volunteers from any and all liability, claims, demands, actions or rights of action, which are related to, arise out of, or are in any way connected with my participation in this activity, including those allegedly attributed to the negligent acts or omissions of the above mentioned parties. This agreement shall bebinding upon me, my successors, representatives, heirs, executors, assigns, or transferees. If anyportion of this agreement is held invalid, I agree that the remainder of the agreement shall remain infull legal force and effect. If I am signing on behalf of a minor child, I also give full permission for any person connected with The Resistance Gym 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.
Do you understand and agree?
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I understand and agree
Indemnification
The participant recognizes that there is risk involved in the types of activities offered by The Resistance Gym. Therefore the participant accepts financial responsibility for any injury that 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 The Resistance Gym, 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 The Resistance Gym, at the main building or abroad. This includes but is not limited to parks, recreational areas, playgrounds, areas adjacent to main building, and/or any area selected for training by The Resistance Gym.
Do you understand and agree?
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I understand and agree
Signature
I have read and understood 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.
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First Name
Last Name
Date
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Day
Year
Date
Signature
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