Bodyworx Fit!
Strength + Cardio + Nutrition

Questionnaire and Waiver Forms

Questionnaire

Please fill out the questionnaire below and submit prior to attending your first Fit Camp. A printed copy will be available for your signature when you arrive. Welcome! :)

First and Last Name:

Mailing Address:

City:

State:

Zip:

Mobile phone number:

Home phone number:

Emergency contact:

Emergency contact phone:

Email address:

Confirm email address:

How did you hear about Bodyworx Fit Camps?:

What are your fitness goals?:

What physical activities are you currently participating in?:

Do you have any physical limitations preventing you in any way?:

Do you have any specific questions for the trainers?:

Please list allergies to any medications (aspirin, penicillin, sulfa, etc.)?:

Do you take any prescription medications, either permanently or semi-permanently?:

Do you have or have you ever had the following:
          Diabetes, adult or juvenile? Yes
          Asthma? Yes
          Anemia? Yes
          High blood pressure (hypertension)? Yes
          Seizure disorder (epilepsy)? Yes
          Heart disease? Yes
          Lung disease?   Yes
          Kidney disease? Yes
          Liver disease?   Yes

Do you wear glasses or contact lenses?

Have you had a broken bone or fracture in the last two years? If yes, describe:

List any surgical procedures you have had:

Have you had knee pain in the past two years that has disabled you for more than two weeks?:

Do you have back pain? If yes, describe when it occurs:

Have you ever been knocked out? If yes, describe the situation:

Acknowledgement:

I recognize and acknowledge that as a recipient of the personal training / fit camp services provided by Bodyworx Fit, I or my minor / ward will periodically engage on strenuous physical activities involving the use of weight training and other exercise equipment such as treadmills, free weights, elliptical machines, exercise bikes, chest presses and squat racks among other equipment, which activities entail the risk of serious physical and other injuries, including, but not limited to broken bones, sprains, bruises, concussions, heart attack, viral or other pathogen infection, and in some cases, permanent disability and even death. I also understand that severe social and economic loss might result not only from my own actions but also from the actions, interactions or negligence of others, or the condition of the premises or equipment used in connection with such activities. Nevertheless, I agree to assume the risk of any injury, damage or loss regardless of severity that I, my minor child / ward, or other family member or kin may sustain as a result of the activities I engage in as provided by the Company.
Accordingly, I agree to waive, relinquish, discharge, release and covenant not to sue Melanie Morrissey, Bodyworx Fit, or its’ parent, sister, affiliated and/or subsidiary corporations and related entities, their members, owners, officers, directors, partners, employees, consultants, contractors, advisors, agents, insurers, attorneys and volunteers, from any and all rights, claims of injury, demands, causes of action, damages, liabilities or loss that I, my minor child / ward, or other family member may have or that may accrue to me, my minor child / ward or other family members arising out of, connected with, or in any way associated with the personal training / boot camp services provided by the Company.
Notwithstanding the foregoing and any other provision of this Agreement, I do not waive any rights that I may have to seek redress due to the reckless or intentional conduct of any individual or entity. I have considered that if this Agreement were not as broad in scope as it is, the cost of the personal training /fit camp services would be considerably higher and I do not wish to pay a considerably higher cost.
By signing this Agreement, I waive
the right to bargain for different terms in this Agreement. I also understand that if I later learn that any fact that I believed to be true at the time I signed this Agreement is later found to be incorrect, I am nevertheless bound by this Agreement. I have read this Agreement thoroughly and fully understand it. I enter into it voluntarily on behalf of myself, my spouse, my heirs, next of kin, assigns, personal representatives, related individuals and related entities. No one has made to me any representations, statements, or inducements that change or modify anything written in this Agreement.

Do you agree to the following:

I will remember to set my alarm and be at camp on time. Any violation will result in twenty push-ups per occurrence.

I agree not to use foul language during Boot Camp. Any violation will result in twenty push-ups per occurrence.

I understand that photos or video may be taken during the course of my involvement in Bodyworx Fit Camp, which may be used for promotional purposes.

I understand that my coach and Bodyworx Fit will from time-to-time send me informative emails with motivation, health, and fitness tips via a newsletter or a personal message.

I understand there is no refund policy.

By signing up for camp, I am making a commitment to myself. I am committed to a fit and healthy lifestyle. I understand that Bodyworx Fit Camp will accept no excuses for my failure to fulfill my commitment to myself.

Your signature will be required at the time of your evaluation, and you agree to the terms now!:

I agree