Application, Medical Questionnaire, Release, Waiver of Liability and Indemnity

Agreement with Faith-Fitness Bootcamp.

Full Name ______________________________________________________

Date of Birth _____________

Street Address _______________________________________________

City __________________________________________________

State____________ Zip______________________

Home Phone #__________________________

Cell Phone #__________________________

Email_____________________________________________

I understand that it is my responsibility to consult with a physician prior to and regarding my

participating in the fitness classes and boot camp classes with Faith-Fitness Bootcamp and to receive

prior approval to participate. I represent and warrant that I am physically fit and I have no medical

condition or injury, which would prevent my full participation in the fitness classes and boot camp

classes Faith-Fitness Bootcamp.

Personal Health History

Do you have any additional conditions that may prevent you from performing fitness training and boot

camp classes? For example, knee problems, heart condition, etc:

__________________________________________________________

__________________________________________________________

__________________________________________________________

I understand that it is my continuing responsibility to inform the instructor(s) at Faith-Fitness Bootcamp_

of any previous medical conditions, injuries or surgeries prior to my first class and at such other times as

I acquire information as to same.

Have you participated in a boot camp class before this class? [ ] YES [ ] NO

For and in consideration of being allowed to receive fitness training and boot camp classes from Faith-

Fitness Bootcamp, and the mutual covenants contained in this Agreement, and other good and valuable

consideration, the receipt and sufficiency of which is hereby acknowledged, the undersigned

____________________ (client) agrees to the following:

1. I, _____________________ (client), do fully comprehend and assume all risks involved in participating

in fitness training and boot camp classes. I have been advised by Faith-Fitness Bootcamp, to consult my

physician prior to my participation in fitness training and boot camp classes to insure that I am physically

able to engage in strenuous physical activity.

2. Being fully cognizant, and assuming all risks involved in the fitness training and boot camp classes

from Faith-Fitness Bootcamp. I do hereby remise, release, quitclaim, and forever discharge Faith-Fitness

Bootcamp, its employees or agents, administrators, successors and assigns, of and from any and all

manner of actions, suits, damages, judgments, executions, claims, or demands whatsoever in law or

equity, or otherwise, against Faith-Fitness Bootcamp, its employees or agents, administrators,

successors and assigns, which I, my heirs, executors, or administrators hereafter can, shall or may have,

for, upon or by reason of any injury that I may sustain or incur while participating in the fitness training

and boot camp classes Faith-Fitness Bootcamp, or while engaging in physical conditioning exercises.

3. In consideration of being allowed to participate in said fitness training and boot camp classes of Faith-

Fitness Bootcamp, I do hereby assume all risks of my involvement and do covenant and agree not to

bring legal action for damages should I sustain any injury, and do further release Faith-Fitness

Bootcamp, its employees or agents, administrators, successors and assigns from all acts of active or

passive negligence on the part of Faith-Fitness Bootcamp, its employees or agents, administrators,

successors and assigns.

4. I also agree to INDEMNIFY AND HOLD release Faith-Fitness Bootcamp, its employees or agents,

administrators, successors and assigns harmless from any and all claims, actions, suits, procedures,

costs, expenses, damages, and liabilities, including attorney’s fess brought as a result of my involvement

in said fitness training and boot camp classes and to reimburse them for any such expenses incurred.

Witness my signature this _______________ (date).

____________________________

(Printed Name of Client)

____________________________

(Signature of Client)

____________________________

(Printed Name of Witness)

______________________________

(Signature of Witness)

as set forth in said Agreement and join in all waivers and releases of hold Faith-Fitness Bootcamp, its

employees or agents, administrators, successors and assigns as set forth therein.

CONSENT AS TO MEDICAL CARE

In addition, in the event of an emergency or non-emergency situation requiring medical treatment, the

undersigned Parents or Legal Guardians hereby grant permission for any and all medical and/or dental

attention to be administered to Client, in the event of an accidental injury or illness. This permission

includes, but is not limited to, the administration of first aid, the use of an ambulance, and the

administration of anesthesia and/or surgery, under the recommendation of qualified medical personnel.

The undersigned request that we be contacted as soon as possible in the case such medical care is

necessary or appears to be necessary.

WITNESS our signatures as of the ____day of _____________, 20_____.

____________________________

(Printed Name of Parent or Guardian)

____________________________

(Signature of Parent or Guardian)

_______________________________

(Printed Name of Parent or Guardian)

_______________________________

(Signature of Parent or Guardian)

____________________________

(Printed Name of Witness)

____________________________

(Signature of Witness)

If Client is under the age of eighteen (18), Parents or Guardians must also sign the following

Agreement.

The undersigned ____________________________________ (Names of Parents or Guardians), declare

that we are the Parents or Legal Guardians of the above named Client. In such capacity as Parents or

Legal Guardians, we acknowledge that we have carefully read this Agreement and we do hereby assume

all responsibilities and obligations of Client as set for therein and do specifically agree to indemnify and

hold Faith-Fitness Bootcamp, its employees or agents, administrators, successors and assigns harmless