CLIENT INTAKE FORM

 
 
Name *
Name
Phone *
Phone
Mailing Address *
Mailing Address
Date of Birth *
Date of Birth
Your Goals (check all that apply) *
WAIVER and RELEASE OF LIABILITY While training at Rise Athletics and Wellness with or without a Coach. While training at any facility with a Rise Athletics and Wellness Coach. While engaging in any activity, at any time, in any place, as a part of a fitness or nutrition program created by Rise Athletics and Wellness. I understand that physical exercise can be strenuous and subject to risk of serious injury, you are urged to obtain a physical examination from a doctor before participating in any exercise. You agree that if you engage in any physical exercise or activity, you do so entirely at your own risk. Any recommendation for changes in diet including the use of food supplements and weight reduction products are entirely your responsibility and you should consult a physician prior to undergoing any dietary or food supplement changes. You agree that you are voluntarily participating in these activities and assume all risks of injury, illness or death. This waiver and release of liability includes, without limitation, all injuries and illness which may occur as a result of: (a) your participation in any activity or personal training session and (b) instruction, training, supervision, dietary, or supplement recommendations by Rise Athletics and Wellness. You acknowledge that you have carefully read this “Waiver and Release of Liability Form” and fully understand that it is a release of liability. You expressly agree to release and discharge Rise Athletics and Wellness and your Coach from any and all claims or causes of action and you agree to voluntarily give up or waive any right that you may otherwise have to bring legal action against Rise Athletics and Wellness and your Coach for personal injury, illness, death, or property damage. To the extent that statute or case law does not prohibit release for negligence, this release is also for negligence on the part of Rise Athletics and Wellness and your Coach. If any portion of this release from liability shall be deemed by a Court of competent jurisdiction to be invalid, then the remainder of this release from liability shall remain in full force and effect and the offending provision or provisions severed here from. By signing this release, I acknowledge that I understand its content and that this release cannot be modified orally. *