Spirit & Soul Fitness Informed Consent and Waiver Release

Welcome to Spirit & Soul Fitness. Your health is of vital importance to us, and in order to provide you with the most appropriate fitness/class/massage program, we need to obtain a brief health history. We will be utilizing this information to design a safe and appropriate exercise program that meets your specific needs. Please complete this form prior to beginning your wellness, coaching, or exercise program with us. Thank you!

First & Last Name

Date of Birth

Phone Number

Emergency Contact Name & Phone

List any relevant injuries or health concerns that could impact your ability to perform physical activities

I acknowledge that engaging in a health and fitness program is potentially hazardous and could result in bodily injury. I acknowledge further and agree that Adventure Fitness LLC DBA Spirit N Soul Fitness, its officers, agents, owner, and independent contractors (under their licensed businesses), do not undertake any responsibility for the participant at any time while engaging in activity provided by Adventure Fitness (dba Spirit N Soul Fitness, address 112 B Delaware Road, Riegelsville, PA 18077), either outside or at any other off-site business supervised event. The undersigned participant claims responsibility for themselves, their heirs, administrators, and executors do hereby agree, intending to be legally bound hereby, that the undersigned and anyone acting under them or through them shall and by this presence do indemnify, hold harmless and excuse Adventure Fitness LLC (dba Spirit N Soul Fitness) and its officers, owners, agents and partnering independent contractors from any and all expenses, costs, charges, bills, claims, damages, lawsuits and liability for bodily harm or injury caused by participant or any other person or entity during the course of the activity, or as a result of the activity.

Photo/Video Disclaimer: In attending classes, there may be promotional photos/videos taken; you are authorizing the use of these for promotional purposes. If you wish to abstain, please notify your instructor or the photographer

Client Initials

Date

Parent or Guardian Name (if client under 18 years old)

Thanks for submitting!