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Canton, GA. 30114

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E3351288-0883-4F01-9DB1-DB8E48713F0D_edi

Gym & Fitness Liability Waiver

First Name

Last Name

Email

Date of Birth

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

No

Yes

Parent or Guardian Information

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.

Your Signature

Thanks for submitting!

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