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Safety Waiver

To register to our gym please fill out the following medical form

First Name

Email Address

Last Name

Date of Birth

Do you have Asthsma? *

No

Yes

Have you lost your consciousness in the last past 12 months? *

No

Yes

I hereby affirm that I am voluntarily starting a course of instruction in physical fitness and performance training (The Activity). I am voluntarily participating in the Activity entirely at my own risk.

Initials

Today's Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

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