Bootcamp Inquiry

Contact

First Name (Required)

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General Health Questions

Has your doctor ever said you have a heart condition? (Required)

YesNo

Has your doctor recommended that you get clearance before starting an exercise program? (Required)

YesNo

Do you feel pain your chest when you do physical activity? (Required)

YesNo

In the past month, have you had chest pain when you were not doin physical activity? (Required)

YesNo

In the past month, have you had chest pain when you were not doing physical activity? (Required)

YesNo

Do you lose your balance because of dizziness or do you ever lose consciousness? (Required)

YesNo

Do you have a bone or joint problem (for example back, knee or hip) that could be made worse by a change in your physical activity? (Required)

YesNo

Is your doctor currently prescribing drugs (for example water pills) for your blood pressure or heart condition? (Required)

YesNo

Do you know of any other reason why you should not do physical activity? (Required)

YesNo

Release of Liability

Waiver

BY SIGNING THIS DOCUMENT YOU ARE WAIVING CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE – PLEASE READ CAREFULLY Through the purchase of training sessions, have agreed to voluntarily participate in an exercise program including, but not limited to, cardiorespiratory, muscular and flexibility training under the guidance of Craig Cochrane and VT2 Fitness. I hereby stipulate and agree that I am physically and mentally sound and currently have no physical conditions that would be aggravated by my involvement in an exercise program. I have provided verification from a licensed physician that I am able to undertake a general fitness training program. I understand and am aware that physical fitness activities, including the use of equipment, are potentially hazardous activities. I am aware that participating in these types of activities, even when performed properly, can be dangerous. I agree to follow the verbal instructions issued by the personal trainer. I am aware that potential risks associated with these activities include, but are not limited to: death, fainting, disorders in heartbeat, serious neck and spinal injuries that may result in complete or partial paralysis or brain damage, serious injury to virtually all bones, joints, ligaments, muscles, tendons and other aspects of the musculoskeletal system, and serious injury or impairment to other aspects of my body, general health and well-being. I understand I am responsible for my own medical insurance and will maintain that insurance throughout the entire period of participation with Craig Cochrane and VT2 Fitness. I will assume any additional expenses incurred that go beyond my health coverage. I will notify Craig Cochrane and VT2 Fitness or any significant injury or change in health status that requires medical attention (such as emergency care, hospitalization etc) Craig Cochrane and VT2 Fitness will provide the equipment to be used in connection with workouts, including, but not limited to benches, dumbbells, barbells and similar items. I represent and warrant any and all equipment I provide for training sessions is for personal use only Craig Cochrane and VT2 Fitness has not inspected the equipment and has no knowledge of its condition. I understand I take sole responsibility for my equipment. I acknowledge that although Craig Cochrane and VT2 Fitness take precautions to inspect and maintain the equipment, any equipment may malfunction and/or cause potential injuries. I take sole responsibility to inspect any and all of my or Craig Cochrane and VT2 Fitness equipment prior to use. Although Craig Cochrane and VT2 Fitness will take precautions to ensure my safety. I expressly assume and accept sole responsibility for my safety and for any and all injuries that may occur. In consideration to the acceptance of this entry, I, for myself and for my executors, administrators and assigns waive and release any and all claims against Craig Cochrane and VT2 Fitness and any of their staff, officers, officials, volunteers, sponsors, agents, representatives, successors or assigns and agree to hold them harmless from any claims or losses, including but not limited to claims for negligence for any injuries or expenses that I may incur while exercising or while traveling to and from training sessions. These exculpatory clauses are intended to apply to any and all activities occurring during the time for which I have contracted with Craig Cochrane and VT2 Fitness. I represent and warrant that I am signing this agreement freely and wilfully and not under fraud or duress. HAVING READ THE ABOVE TERMS AND INTENDING TO BE LEGALLY BOUND HEREBY AND UNDERSTANDING THIS DOCUMENT TO BE A COMPLETE WAIVER AND DISCLAIMER IN FAVOR OF CRAIG COCHRANE AND VT2 FITNESS I HEREBY AFFIX MY SIGNATURE HERETOthrough the purchase of training sessions, have agreed to voluntarily participate in an exercise program including, but not limited to, cardiorespiratory, muscular and flexibility training under the guidance of Craig Cochrane and VT2 Fitness. I hereby stipulate and agree that I am physically and mentally sound and currently have no physical conditions that would be aggravated by my involvement in an exercise program. I have provided verification from a licensed physician that I am able to undertake a general fitness training program. I understand and am aware that physical fitness activities, including the use of equipment, are potentially hazardous activities. I am aware that participating in these types of activities, even when performed properly, can be dangerous. I agree to follow the verbal instructions issued by the personal trainer. I am aware that potential risks associated with these activities include, but are not limited to: death, fainting, disorders in heartbeat, serious neck and spinal injuries that may result in complete or partial paralysis or brain damage, serious injury to virtually all bones, joints, ligaments, muscles, tendons and other aspects of the musculoskeletal system, and serious injury or impairment to other aspects of my body, general health and well-being. I understand I am responsible for my own medical insurance and will maintain that insurance throughout the entire period of participation with Craig Cochrane and VT2 Fitness. I will assume any additional expenses incurred that go beyond my health coverage. I will notify Craig Cochrane and VT2 Fitness or any significant injury or change in health status that requires medical attention (such as emergency care, hospitalization etc) Craig Cochrane and VT2 Fitness will provide the equipment to be used in connection with workouts, including, but not limited to benches, dumbbells, barbells and similar items. I represent and warrant any and all equipment I provide for training sessions is for personal use only Craig Cochrane and VT2 Fitness has not inspected the equipment and has no knowledge of its condition. I understand I take sole responsibility for my equipment. I acknowledge that although Craig Cochrane and VT2 Fitness take precautions to inspect and maintain the equipment, any equipment may malfunction and/or cause potential injuries. I take sole responsibility to inspect any and all of my or Craig Cochrane and VT2 Fitness equipment prior to use. Although Craig Cochrane and VT2 Fitness will take precautions to ensure my safety. I expressly assume and accept sole responsibility for my safety and for any and all injuries that may occur. In consideration to the acceptance of this entry, I, for myself and for my executors, administrators and assigns waive and release any and all claims against Craig Cochrane and VT2 Fitness and any of their staff, officers, officials, volunteers, sponsors, agents, representatives, successors or assigns and agree to hold them harmless from any claims or losses, including but not limited to claims for negligence for any injuries or expenses that I may incur while exercising or while traveling to and from training sessions. These exculpatory clauses are intended to apply to any and all activities occurring during the time for which I have contracted with Craig Cochrane and VT2 Fitness. I represent and warrant that I am signing this agreement freely and wilfully and not under fraud or duress. HAVING READ THE ABOVE TERMS AND INTENDING TO BE LEGALLY BOUND HEREBY AND UNDERSTANDING THIS DOCUMENT TO BE A COMPLETE WAIVER AND DI SCLAIMER IN FAVOR OF CRAIG COCHRANE AND VT2 FITNESS I HEREBY AFFIX MY SIGNATURE HERETO

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Please type your full name and the date below to show you agree and understand all the terms mentioned above

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