Welcome to
PreScreen Questionnaire and Waiver
Full Name
Phone
*
Email
*
What is the #1 Result you are looking for?
*
Why do you want achieve these goals? eg. Feel better, look better, live longer.. etc
*
How did you hear about us?
*
Internet
Social Media
Facebook Ads
Referral
Walk In
Other
Have you trained before?
*
Yes
No
How often are you planning to train a week?
2-3 Times
4+ Times
Do you have any pre existing health conditions that may impact your training?
Yes
No
If yes. Please provide more information about your pre existing health conditions.
Do you have any pre existing or current injuries that may affect your training? eg. back, knee
Yes
No
Please provide more information about your pre existing or current injuries
Are you clear to exercise from your injuries or being post partum?
Yes
No
I agree to the terms and conditions of your training facility. By participating in the workouts, I hereby assume the risks of any injuries that I may sustain on the premises. I hereby remise, release and forever discharge your facility from any liability, responsibility or actions suits, damages claims or judgements that may results from any personal injury or even death I may sustain while on the premise, as a result of my participate in the workout during my trial or membership term.
*
Yes
No
Date
Guardian Name (If participants under age of 18)
Signature Panel (must be 18+)
*
Clear
Submit
For more information please contact us below
[email protected]