Vaaghlife Applicant Assessment Form

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Name
Selected Value: 0
P.A.R.Q - Have you ever suffered from:
Please TICK any activity that you have participated in the past, or any activity you would like to participate in the future
Please TICK any of the following that you would like to accomplish now or in the future.
EATING HABITS - Do you...
Grocery List - Please TICK all the foods you eat and that you really ENJOY. This helps me to prescribe an Eating Plan with item you eat and enjoy, enabling you to follow and stick to your eating plan.
Waiver, Release and Assumption of Risk
This form is an important legal document. It explains the risks you are assuming by beginning an exercise program.

It is critical that you read and understand completely. After you have done so, please print your name legibly and sign in the spaces provided at the bottom.

Waiver, informed Consent, and Covenant not to sue

I have volunteered to participate in a program of physical exercise under the direction of any one of FITNESS RAGE staff which will include, but may not be limited to , weight and/or resistance training. In consideration of anyone of Fitness Rage staff agreement to instruct, assist and train me, I do here and forever release and discharge and herby hold harmless any one of Fitness Rage staff from any and all claims, demands, damages, rights of action, present or future, arising out of or connected with my participation in this or any exercise program including any injuries resulting there from. I understand and am aware that strength, flexibility and aerobic exercise, including the use of the equipment, are potentially hazardous activities. I also understand that fitness activities involve a risk of injury and even death, and that I am voluntarily participating in these activities and using equipment and machinery with the knowledge of the dangers involved. I hereby agree to expressly assume and accept all risks of injury and death.

I do hereby further declare myself to be physically sound and suffering from no condition that would prevent my participation or use of machinery or equipment. I acknowledge that I have either had a physical examination and have been given Doctors permission to participate, or that I have decided to participate in activity and use machinery and equipment without approval of my Doctor and do hereby assume all responsibility for my participation and activities, and utilisation of machinery and equipment in my activities.

I acknowledge that I have thoroughly read this waiver and release and fully understand that it a release of liability, by signing this document, I am wavering any right my successors or might have to bring action or assert a claim against any one of Fitness Rage staff or Fitness Rage.