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Open House Packet

PARTICIPANT RELEASE AND KNOWLEDGE OF AGREEMENT 

 

  1. I wish to participate in the exercise and training program offered by Renu Health & Fitness. I understand there are inherent risks in participating in a program of strenuous exercise including but not limited to, heart attacks, muscle strains, pulls or tears, broken bones, shin splints, heat prostration, knee/lower back/ foot injuries and any other illness, soreness, or injury however caused, occurring during or after participant participation in the physical activities. I further acknowledge that such risks include, but are not limited to, injuries caused by the negligence of an instructor or other person, defective or improperly used equipment, over exertion, slip or fall by myself, or an unknown health problem of mine. I agree to assume all risk and responsibility involved with participation in the physical activities, I affirm that I am in good physical condition and do not suffer from any disability that would prevent or limit participation in the physical activities.

    By signing I assert that I can participate in physical activities. I agree to assume all risk and responsibility for not exceeding my physical limits. I also understand photos and or video may be taken during my involvement, which may be used for promotional purposes.

    I agree that Renu Health & Fitness, Dino Nowak, Nowak Enterprises, Guardian Strategic Ventures it’s employees, contractors, officers, or owner/s..., shall not be liable or responsible for any injuries to me resulting from my participation in the fitness program (whether at home, at the training studio, outdoors, or at a corporate, commercial, residential or other fitness facility) and I expressly release and discharge the above from all claims, actions, judgments and the like which I or my heirs, executors, administrators or assigns may have or claim to have as a result of any injury or other damage which may occur in connection with my participation in the fitness program. This Release shall be binding upon my heirs, executors, administrators and assigns.

    I have read and understand this term:

  2. I certify that the answers to the questions outlined on the PAR-Q form (below) are true and complete to the best of my knowledge. I understand and agree that it is my responsibility to inform my Trainer of any conditions or changes in my health, now and ongoing, which might affect my ability to exercise safely and with minimal risk of injury.

    I have read and understand this term: 

  3. I understand that I am not obligated to perform nor participate in any activity that I do not wish to do, and that it is my right to refuse such participation at any time during my training sessions. I understand that should I feel lightheaded, faint, dizzy, nauseated, or experience pain or discomfort, I am to stop the activity and inform my Personal Trainer right away.

    I have read and understand this term:

  4. I understand that all Semi-Private rates are based on 45-50 minute sessions and should I arrive late, there is no guarantee I will receive the full session with my trainer

    I have read and understand this term: 

  5. I understand that the usage of any nutritional supplements is done under my own will and has not been prescribed by my Coach.

    I have read and understand this term: 

  6. To keep our members safe PLEASE no socks on the concrete floors as they can be slippery with just socks. If doing Yoga go barefoot or wear yoga socks with grip on the bottom. By initialing you understand this risk and agree you will not wear socks on the concrete floor. 

    ​I understand and agree to the above and release Renu, Guardian Strategic Ventures, Nowak Enterprises it's officers, family any and all associated with Renu if I fall do to not adhering to this warning and requirement. 
    I have read and understand this term:

    ​

Date: March 5, 2021

 

 

First Guests Name

First Name*

Last Name*

Phone*
First Guests Date of Birth*
First Guests Preferences

Music you like to exercise to: *

Favorite Musicians:
Session Time you would like to attend.*
First Guests Signature*
Second Guests Name

First Name*

Last Name*
Second Guests Date of Birth*
Second Guests Preferences

Music you like to exercise to: *

Favorite Musicians:
Session Time you would like to attend.*
Third Guests Name

First Name*

Last Name*
Third Guests Date of Birth*
Third Guests Preferences

Music you like to exercise to: *

Favorite Musicians:
Session Time you would like to attend.*
Fourth Guests Name

First Name*

Last Name*
Fourth Guests Date of Birth*
Fourth Guests Preferences

Music you like to exercise to: *

Favorite Musicians:
Session Time you would like to attend.*
Fifth Guests Name

First Name*

Last Name*
Fifth Guests Date of Birth*
Fifth Guests Preferences

Music you like to exercise to: *

Favorite Musicians:
Session Time you would like to attend.*
Sixth Guests Name

First Name*

Last Name*
Sixth Guests Date of Birth*
Sixth Guests Preferences

Music you like to exercise to: *

Favorite Musicians:
Session Time you would like to attend.*
Seventh Guests Name

First Name*

Last Name*
Seventh Guests Date of Birth*
Seventh Guests Preferences

Music you like to exercise to: *

Favorite Musicians:
Session Time you would like to attend.*
Eighth Guests Name

First Name*

Last Name*
Eighth Guests Date of Birth*
Eighth Guests Preferences

Music you like to exercise to: *

Favorite Musicians:
Session Time you would like to attend.*
Ninth Guests Name

First Name*

Last Name*
Ninth Guests Date of Birth*
Ninth Guests Preferences

Music you like to exercise to: *

Favorite Musicians:
Session Time you would like to attend.*
Tenth Guests Name

First Name*

Last Name*
Tenth Guests Date of Birth*
Tenth Guests Preferences

Music you like to exercise to: *

Favorite Musicians:
Session Time you would like to attend.*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Par Q Form
Has your Doctor ever said you have a heart condition and recommended only medically supervised physical activity?*
No
Yes
Do you frequently have pains in your chest when you perform physical activity?*
No
Yes
Have you had chest pain when you were NOT doing physical activity?*
No
Yes
Do you lose your balance DUE to dizziness or do you ever lose consciousness?*
No
Yes
Do you have a bone, joint or any other health challenge that causes you pain or limitations that must be addressed when developing an exercise program? (i.e. diabetes, osteoporosis, high blood pressure, high cholesterol, arthritis, shoulder, knee or back pain)*
No
Yes
Have you had a recent surgery?*
No
Yes

If you marked yes to any of the above, please elaborate below
Do you take any medications, either prescription or non prescription on a regular basis?*
No
Yes

If so what is the medication for?

Is there anything else we should know that could impact your ability to engage in physical activity?
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Preferences

Music you like to exercise to: *

Favorite Musicians:
Session Time you would like to attend.*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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