IQFit Fitness Consultation Form 2017

Intake Form for Prospective Members
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Medical Health History

Describe any past or current musculoskeletal conditions you have incurred (muscle pulls, sprains, strains fractures, surgeries, pain or general tightness and/or discomfort.)

Please list 3 goals you want to accomplish here at IQFIT, in order of importance; and why each one is important to you:

WAIVER & RELEASE FORM

Because physical exercise can be strenuous and subject to risk of serious injuries, IQFit urges you to obtain physical examination from a doctor before using any exercise equipment or participating in any exercise activity. You (each member, guest and all participating family members) agree that if you engage in any physical exercise or activity, or use any club amenity on the premises or off the premises, including any IQFit sponsored event, you do so entirely at your own risk. Any recommendation for changes in diet, including the use of food supplements, weight reduction and/or body building enhancement products are entirely your responsibility and you should consult a physician prior to undergoing any dietary or food supplement changes. You agree that you are voluntarily participating in these activities and use of these facilities and premises and assume all risks of injury, illness or death. We are also not responsible for any loss of your personal property. This waiver and release of liability includes, without limitation, all injuries which may occur, regardless of negligence, as a result of; (a) your use of all amenities and equipment in the facility and your participation in any activity, class, or program, personal training or instruction; (b) the sudden and unforeseen malfunctioning of any equipment; (c) our instruction, training, supervision, or dietary recommendations; and (d) your slipping and/or falling while in the club or on IQFit premises including adjacent side-walks and parking areas. With the signature below you grant IQFit and its licensees permission to publish your personal profile and/or testimonial and any accompanying photographs in any media now known or hereafter invented (including online interactive products) without further cost or any time or geographic limitation. You also authorize IQFit and its licensees to use your name, personal profile and/or testimonial, photo and/or right to use your likeness in/for advertisements and publicity efforts for IQFit, including promotions on the Internet. At the same time, you recognize that IQFit is under no obligation to use or distribute this material. You acknowledge that you have carefully read this “waiver & release” and fully understand that it is a release of liability. you expressly agree to release and discharge IQFit and all affiliates, employees, agents, representatives, successors or assigns from any and all claims or causes of action and you agree to voluntarily give up or waive any right that you may otherwise have to bring legal action against IQFit for negligence, personal injury or property damage. To the extent that statute or case law does not prohibit releases for negligence, this release is also for negligence on the part of IQFit, its agents and employees. If any portion of this release from liability is deemed by a Court of competent jurisdiction to be invalid, then the remainder of this release shall remain in effect and the offending provision(S) severed here from.
By typing your name and hitting the submit button, you agree that all information you provided is accurate. You also agree to the waiver and release form.
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