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New Member Inquiry Form

Name
First Last
Address
Street Address City State / Province / Region ZIP / Postal Code
Phone
Email
Gender
Age
Birthdate
How did you hear about us? Please be specific.
Are there any previous/current injuries? (Neck, Back, Hips, Knees, Shoulders) Please be specific.
Previous Surgeries:
Specifically, what are your health or fitness goals (weight loss, lose inches, muscle gain)?
Liability Release

In consideration of permission to use, today and on all future dates, the property, facilities, and services of Elite Personal Fitness and to participate in weight training, cardiovascular training, and other physical activities, Client, on behalf of himself or herself, his or her heirs, personal representatives, and assigns, does hereby release, waive, and discharge Elite Personal Fitness, its parent corporation, Samurai Strength and Conditioning, LLC, both entities’ employees, volunteers, independent contractors, officers and agents (collectively, the “Released Parties”) from liability from any and all claims arising from Client’s own negligence, the negligence of others, or the Released Parties’ negligence originating from Client’s participation in this program. This Agreement applies to: 1) personal injury (including death) from accidents or illnesses arising from the participation in physical activities including, but not limited to, organized activities, classes, observation, and individual use of facilities, premises, or equipment; and 2) any and all claims resulting from the damage to, loss of, or theft of property. Client certifies that he or she knows of no medical problem (except those noted herein) that would increase his or her risk of illness and injury as a result of participating in a physical training program. Client understands that he or she has been advised to consult a physician prior to commencement of a physical training program to ensure his or her state of wellness to participate in such strenuous activities. Client agrees to indemnify and hold the Released Parties harmless for any loss caused by Client for which the Released Parties are held liable including attorney’s fees and arbitration costs.

Client Consent

Client consents to and releases each of Elite Personal Fitness and its parent company, Samurai Strength and Conditioning, LLC, from any liability resulting from Elite Personal Fitness and/or Samurai Strength and Conditioning, LLC use of Client’s name and likeness in Elite Personal Fitness and/or Samurai Strength and Conditioning, LLC advertising, promotional and marketing materials, client lists, Web Site, and/or other public relations documents.
Date
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