Application, Medical Questionnaire, Release, Waiver of Liability and Indemnity
Agreement with Faith-Fitness Bootcamp.
Full Name ______________________________________________________
Date of Birth _____________
Street Address _______________________________________________
City __________________________________________________
State____________ Zip______________________
Home Phone #__________________________
Cell Phone #__________________________
Email_____________________________________________
I understand that it is my responsibility to consult with a physician prior to and regarding my
participating in the fitness classes and boot camp classes with Faith-Fitness Bootcamp and to receive
prior approval to participate. I represent and warrant that I am physically fit and I have no medical
condition or injury, which would prevent my full participation in the fitness classes and boot camp
classes Faith-Fitness Bootcamp.
Personal Health History
Do you have any additional conditions that may prevent you from performing fitness training and boot
camp classes? For example, knee problems, heart condition, etc:
__________________________________________________________
__________________________________________________________
__________________________________________________________
I understand that it is my continuing responsibility to inform the instructor(s) at Faith-Fitness Bootcamp_
of any previous medical conditions, injuries or surgeries prior to my first class and at such other times as
I acquire information as to same.
Have you participated in a boot camp class before this class? [ ] YES [ ] NO
For and in consideration of being allowed to receive fitness training and boot camp classes from Faith-
Fitness Bootcamp, and the mutual covenants contained in this Agreement, and other good and valuable
consideration, the receipt and sufficiency of which is hereby acknowledged, the undersigned
____________________ (client) agrees to the following:
1. I, _____________________ (client), do fully comprehend and assume all risks involved in participating
in fitness training and boot camp classes. I have been advised by Faith-Fitness Bootcamp, to consult my
physician prior to my participation in fitness training and boot camp classes to insure that I am physically
able to engage in strenuous physical activity.
2. Being fully cognizant, and assuming all risks involved in the fitness training and boot camp classes
from Faith-Fitness Bootcamp. I do hereby remise, release, quitclaim, and forever discharge Faith-Fitness
Bootcamp, its employees or agents, administrators, successors and assigns, of and from any and all
manner of actions, suits, damages, judgments, executions, claims, or demands whatsoever in law or
equity, or otherwise, against Faith-Fitness Bootcamp, its employees or agents, administrators,
successors and assigns, which I, my heirs, executors, or administrators hereafter can, shall or may have,
for, upon or by reason of any injury that I may sustain or incur while participating in the fitness training
and boot camp classes Faith-Fitness Bootcamp, or while engaging in physical conditioning exercises.
3. In consideration of being allowed to participate in said fitness training and boot camp classes of Faith-
Fitness Bootcamp, I do hereby assume all risks of my involvement and do covenant and agree not to
bring legal action for damages should I sustain any injury, and do further release Faith-Fitness
Bootcamp, its employees or agents, administrators, successors and assigns from all acts of active or
passive negligence on the part of Faith-Fitness Bootcamp, its employees or agents, administrators,
successors and assigns.
4. I also agree to INDEMNIFY AND HOLD release Faith-Fitness Bootcamp, its employees or agents,
administrators, successors and assigns harmless from any and all claims, actions, suits, procedures,
costs, expenses, damages, and liabilities, including attorney’s fess brought as a result of my involvement
in said fitness training and boot camp classes and to reimburse them for any such expenses incurred.
Witness my signature this _______________ (date).
____________________________
(Printed Name of Client)
____________________________
(Signature of Client)
____________________________
(Printed Name of Witness)
______________________________
(Signature of Witness)
as set forth in said Agreement and join in all waivers and releases of hold Faith-Fitness Bootcamp, its
employees or agents, administrators, successors and assigns as set forth therein.
CONSENT AS TO MEDICAL CARE
In addition, in the event of an emergency or non-emergency situation requiring medical treatment, the
undersigned Parents or Legal Guardians hereby grant permission for any and all medical and/or dental
attention to be administered to Client, in the event of an accidental injury or illness. This permission
includes, but is not limited to, the administration of first aid, the use of an ambulance, and the
administration of anesthesia and/or surgery, under the recommendation of qualified medical personnel.
The undersigned request that we be contacted as soon as possible in the case such medical care is
necessary or appears to be necessary.
WITNESS our signatures as of the ____day of _____________, 20_____.
____________________________
(Printed Name of Parent or Guardian)
____________________________
(Signature of Parent or Guardian)
_______________________________
(Printed Name of Parent or Guardian)
_______________________________
(Signature of Parent or Guardian)
____________________________
(Printed Name of Witness)
____________________________
(Signature of Witness)
If Client is under the age of eighteen (18), Parents or Guardians must also sign the following
Agreement.
The undersigned ____________________________________ (Names of Parents or Guardians), declare
that we are the Parents or Legal Guardians of the above named Client. In such capacity as Parents or
Legal Guardians, we acknowledge that we have carefully read this Agreement and we do hereby assume
all responsibilities and obligations of Client as set for therein and do specifically agree to indemnify and
hold Faith-Fitness Bootcamp, its employees or agents, administrators, successors and assigns harmless