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Health Declaration

Please fill out the following form prior to physical activity.

First name

Last name

Email

Date of Birth

Do you have any preexisting medical conditions? *

No

Yes

Do you have any chronic medical conditions? *

No

Yes

If you answered yes to any question, please elaborate

Initials

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

Thanks for submitting!

Gym & Fitness Liability Waiver

First name

Last name

Email

Date of Birth

Do you have a doctor’s permit to participate in intense physical activities?

No

Yes

Please specify anything we should know about

Initials

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

I hereby acknowledge this release from liability for accidental injury or illness which I may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.

Thanks for submitting!

Contact Me

First Name

Last Name

Email

Leave us a message...

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Address

Serving the Otay Ranch/San Diego area

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