IRONGIRLS WAIVER & INTAKE FORM

IRONGIRLS GYM PARTICIPANT INTAKE FORM

Participant's Complete Name

Date of Birth

Phone

Facebook Name

Waiver & Release of Liability (Read Carefully)

Acknowledgment of Risk & Consent to Participate

I understand and acknowledge that participation in workouts, fitness classes, challenges, and other activities at Iron Girls Fitness, Hampton, Virginia, involves inherent risks of injury, including but not limited to strains, sprains, fractures, and in rare cases, serious injury or death.

I have read and agree to the Liability Waiver & Release of Iron Girls Fitness.

Media Release Consent

I consent / do not consent (choose one) to allow Iron Girls Fitness to use my photos/videos for marketing and promotional purposes

I Consent

I Do Not Consent

Emergency Contact #1 (Required)

Emergency Contact #1 Name (Required)

Relationship (Required)

Phone Number (Required)

Emergency Contact #2 (Optional)

Emergency Contact #2 Name (Optional)

Relationship (Optional)

Phone Number (Optional)

Medical Information

Known Medical Conditions (Optional)

Allergies (Optional)

Current Medications (Optional)

Doctor's name if known (Optional)

Doctor's Phone Number if known (Optional)

Authorization & Signature

Parent/Guardian Signature (Required)

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Date of Agreement