HEALTH HISTORY FORM

CLIENT & EMERGENCY CONTACT INFORMATION

IN CASE OF EMERGENCY NOTIFY:

GENERAL MEDICAL HISTORY & INFORMATION

I understand that the personal training I receive is provided for the purpose of exercise instruction and guidance. I further understand that personal trainer(s) are not qualified to perform, diagnose, prescribe, or treat any physical or mental illness, or provide nutritional planning, and that nothing said during the course of the sessions given should be considered as such. I should see a physician, chiropractor, registered dietitian, or other qualified medical specialist for any nutritional concerns, mental or physical ailment that I am aware of. I affirm that I have stated all of my known medical conditions, and answered all questions, honestly. I agree to keep the personal trainer updated as to any changes in my medical profile and understand that there shall not be liability on the personal trainers part, should I forget to do so. I understand that I have enrolled in the personalized health and fitness program offered through City Boot Camp and its personal trainers. I recognize that the program may involve strenuous physical activity, including, but not limited to, muscle, strength and endurance training, cardiovascular conditioning and training, and other various fitness activities. I hereby affirm that I am in good physical condition, and do not suffer from any known, disability or condition, which would prevent or limit my participation in this exercise program. I acknowledge that my enrollment and subsequent participation is purely voluntary, and in no way mandated by City Boot Camp or Chris Sider. In consideration of my participation in this program, I hereby release City Boot Camp, and Chris Sider, any of his personal trainers, and affiliates from any claims, demands, and causes of action as a result of my voluntary participation and enrollment of the provided personal training services, and or exercise classes. I fully understand that I may injure myself as a result of my enrollment and subsequent participation in this program and I hereby release City Boot Camp and Chris Sider, and its personal trainers and affiliates from any liability now or in the future for conditions that I may obtain. These conditions may include, but are not limited to, heart attacks, muscle strains, muscle poles, muscle, tears, broken bones, shin, splints, heart, frustration, injuries to knees, injuries to back, injuries to fit, or any other illnesses, or soreness that I may incur, including death.  I hereby affirm that I have read and fully understand the above statements by click the box below and submitting this information.