WoodlakeFall2017

XPLOSIVEFIT

4 WEEKS FREE VIRTUAL PE CLASSES

After School Enrichment PE Program

School is back in session and XplosiveFit wants to help your kids get off the couch and move!

For the next several weeks join your friends and classmates in a FREE Physical Education class on ZOOM for 30 minutes of movement. Everything from Fitness, Martial Arts, Daily Life Skills Training and even Dance Parties!

Your child will enjoy age/grade specific exercise all while having fun!

Starts September 14th

No School/ No PE September 28th

Mondays at 2:00PM -- T/K and Kinder

Tuesdays at 3PM -- 1st grade

Wednesdays at 3PM -- 2nd grade

Thursdays at 3PM -- 3rd/4th/5th grade

Please complete the information below and we will send you the ZOOM link and password
Child's Full Name *

First Name Last Name
Age of Child *
Birth Date *

Month Day Year
Child's current grade *
Choose PE Session based on child's grade *
Parent *

First Name Last Name
Cell Phone Number *

Area Code Phone Number
Email *
Your Address *

Street Address

Street Address Line 2

City State

Zip Code
Common sense is your best guide when you answer this questionnaire. Please read the questions carefully and answer each one honestly: check YES or NO.

Yes

Has your doctor ever said that your child has a heart condition and that you should only do physical activity recommended by a doctor?

Has your child ever felt pain in their chest when doing physical activity?

In the past month, has your child had chest pain when not doing physical activity?

Has your child lost their balance because of dizziness or ever experienced a a loss of consciousness?

Does your child have any bone or joint problem (for example, back, knee, or hip) that could be worsen by a change in physical activity?

Is your doctor currently prescribing drugs to your child for blood pressure or heart condition?

Do you know of any other reason why your child should not do physical activity?

Please enter any additional information that you would like us to know about your child:
I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction
I am aware of the risks in observing or participating in the activities offered and sponsored by XplosiveFit both virtual or at any location, and I understand that all sports or fitness that I/my child will execute and participate in are entirely at my/their own risk and perils. I assume complete responsibility and liability for those risks and for the injuries that may occur as a result of these risks, even if injuries occur in a manner that is not foreseeable at the time I sign this agreement. I realize that by voluntarily assuming the risks involved, I will be solely responsible for any loss or damage I/they sustain, including personal injuries to me/them, damage to my/their property, or damage arising out of my/their death.

It is further expressly agreed that all strength training, cardiovascular exercise, or any other exercise shall be undertaken by me/them at my sole risk and that Rodrigo Busby and his agents or employees shall not be liable to me/them for claims, demands, injuries, damages, actions or causes of actions, from all acts of active or passive negligence on the part of Rodrigo Busby and his agents or employees. I further expressly agree that I/they will not use equipment improperly. If I have any questions whatsoever, concerning exercise and use of equipment, I agree that I will request instruction from Rodrigo Busby and or his agents or employees.
Initials *

Clear
DO NOT SIGN THIS AGREEMENT UNLESS YOU UNDERSTAND THE TERMS COMPLETELY. IF YOU DO NOT UNDERSTAND, YOU SHOULD SEEK LEGAL COUNSEL.
Client Signature (must be over 18 to sign)
Signature *

Clear
Date *

Month Day Year
Should be Empty:

DO NOT SIGN THIS AGREEMENT UNLESS YOU UNDERSTAND THE TERMS COMPLETELY. IF YOU DO NOT UNDERSTAND, YOU SHOULD SEEK LEGAL COUNSEL.

Client Signature (must be over 18 to sign)