Health Check & Waiver

Health Check & Waiver
Customer Details:
Full Name*

First NameLast Name
Birth Date

MonthDayYear
Address*

Street Address

Zip Code + City

CityState / Province

Postal / Zip Code
Phone Number
E-mail*
example@example.com

Health Check*

	YES	NO	If YES, which?
Do you take any prescription medicine? If "yes" which?
Do you feel any pain in your foot / knee or shoulder joints?
Are you suffering from back pain?
Any surgeries and/or serious injuries? If "yes" which?
Do you suffer from high blood pressure, asthma, diabetes or any other cardiovascular diseases?
Do you suffer from any other (not named) diseases (i.e. infectious diseases / metabolic diseases)? If "yes" which?
Are you pregnant (please let us know! You may only participate at your own risk and after having consulted your doctor.)?
Do you workout regularly (min. 2 x a week)?

Open Gym Rules

I hereby certify...
- that I take up and carry out the training in the "Open Gym" voluntarily and on my own responsibility.
- that I am aware that participation is at my own risk and peril.
- that I register in advance via RESAWOD.
- that I will be extra quiet when walking through the hallway to the box so as not to disturb the neighbours.
- that I do not train in the yard (includes running) when there is no trainer on site.
- That I use equipment properly, clean/disinfect after use, and put it back properly.
- That I listen to music at room volume only.
- that I keep gates and doors closed.
- That I do not drop weights and use drop mats.
- That I let you know if any equipment has been damaged or if I find it damaged.
- That I turn off all lights before leaving the box.
- That I lock the box and return the key properly.
- that training in the Open Gym is only permitted for members and that I will not bring non-members to training.
- That if I violate the rules, I will be excluded from Open Gym training.
Disclaimer

The signatory declares that he/she has read and understood the following declaration:
- The signatory declares that he/she will take up training voluntary at his/her own risk and responsibility.
- The signatory is responsible to provide information about known diseases or other health restrictions.
- The signatory agrees not to drop weights, use drop mats and to properly use equipment, clean/disinfect after usage, and put it back properly.
- The signatory declares to follow all instructions of the coach at site.
- Any accidents caused by wilful intent or gross negligence of the signatory are explicitly excluded from liability.
- In return, Crossfit 40477 and the company VBK Fitness UG (haftungsbeschränkt) undertake to inspect and maintain the equipment regularly in order to avoid any risk of injury.
- The signatory declares that all his/her entered details are accurate, complete and truthful and undertakes the responsibility to keep the information provided up to date.
- The signatory declares that all his/her entered details are accurate and further declares not to raise claims against CrossFit 40477 and the company VBK Fitness UG (haftungsbeschränkt) if any damages or injuries result from participating in the training.
- The signatory agrees that the electronic data which was collected in context of this form and the following health check may be saved and used to provide best possible training.
Date*

MonthDayYear
Date
Signature*

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Name

First NameLast Name
Signature of Guardian

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Health Check & Waiver

Open Gym Rules

Disclaimer