Consent Form

Client's Name

First NameLast Name

Client's Phone Number

Please enter a valid phone number.

Client's Email

example@example.com

Client's Address

Street Address

Street Address Line 2

Town/CityCounty

Postal code

Age

Date of Birth

Date

Gender

MaleFemale

If below 18 years old (minor), please enter name of parent or guardian

First NameLast Name

Parent / Guardian Phone

Please enter a valid phone number.

Emergency Contact Details

First NameLast Name

Phone Number

Please enter a valid phone number.

Have you done any workout program before?

YesNo

If yes, can you please provide more details?

Do you have any physical disability or any health issues/conditions that we should be aware of?

YesNo

If yes, please provide more details.

Do you have any of the following?

Are you pregnant? (For female)

YesNo

Cancellation Policy: If I am unable to attend my booked session, I will agree to pay for the session.

Terms & Conditions:
I First NameLast Name understand that whilst every precaution will be taken to ensure my good welfare & protection, I hereby release any and all liability in the event of an accident, misfortune, damage or loss that may occur to me &/or my property.
In the case of an emergency, I hereby give permission for First Aid to be undertaken. I have & will continue to keep my Instructors fully informed of any physical condition or disability that might prevent or limit my participation. I fully understand that i am participating in a physical activity that may or may not cause physical injury. I agree to declare any health issue, conditions I may have before signing up for the program. I understand if there's any strain or fatigue, I can come out of the exercise to rest and understand that each and every one has its own physical limitations. I fully recognize that any injuries sustained from all the physical activities will be my responsibility. Therefore I release Mark Stanford of any liabilities. I have read and fully understand the terms of the agreement/waiver and accept all of it. As I am responsible for my own personal health, I acknowledge that the instructor cannot diagnose or treat medical diseases or deficiencies & a medical evaluation is advised before starting any exercise program. I have read & agree with these terms and conditions & the cancellation policy.

Client Signature

Date Signed

Date

Client's Consent Form

Consent Agreement