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Date: April 20, 2026

If you answered “YES” to one or more questions, consult with your doctor BEFORE you start becoming more physically active. Tell your doctor about this PAR-Q and to which questions you answered “YES”. You may be able to participate in any activity you wish. Typically, it is recommended to start slow and build up gradually. However, you may need to restrict your activities to those that are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow his/her advice regarding which are safe for you.

If you accurately answered NO to all PAR-Q questions, you likely can start becoming more physically active. It is recommended to start slow and build up gradually. If, at any point before, during or after participating in any physical exercise, you have any concerns about your health or well-being, please consult your doctor before continuing. We regularly invite and encourage clients to participate in “Focus Meeting’s” with our certified trainers. This is an excellent way to get additional information regarding commonly accepted approaches to a healthier lifestyle. This information is not intended and should not be interpreted as medical or dietary advice. You should consult a certified professional for such guidance. It is also highly recommended that you have your blood pressure evaluated and discuss those results with your doctor prior to becoming more physically active.

However, regardless of how you answered the above questions, every individual is unique and you should always err on the side of caution with regard to physical safety, which may include seeking medical evaluations. Please note that if your health changes so that you then answer “YES” to any of the above questions, you must consult your doctor before continuing any physical activities, both in relation to Burn Boot Camp Pensacola and otherwise. We are happy to suggest reasonable modifications to any given exercise. However, any suggested modifications offered by any Burn Boot Camp Pensacola certified trainer should not be interpreted as a safe alternative. Please consult a doctor to determine if any suggested modifications are medically sound.

Delay becoming much more active if you are not feeling well because of a temporary illness such as a cold or a fever – wait until you feel better; or if you are or may be pregnant – talk to your doctor before you start becoming more active.


 

ASSUMPTION OF RISK; WAIVER AND RELEASE OF LIABILITY, RIGHTS AND CLAIMS

THIS AGREEMENT RESULTS IN YOU WAIVING RIGHTS AND POTENTIAL RIGHTS, WHETHER ON YOUR OWN BEHALF AND/OR ON BEHALF OF SOMEONE FOR WHOM YOU ARE AUTHORIZED TO MAKE SUCH DECISIONS AND AGREEMENTS.THE PERSON WHOSE RIGHTS ARE BEING WAIVED AND RELEASED IS THE “RELEASEE”. YOU SHOULD NOT EXECUTE THIS AGREEMENT UNTIL AND UNLESS YOU COMPLETELY UNDERSTAND IT AND UNRESERVEDLY AND IRREVOCABLY CONSENT TO IT. THIS AGREEMENT IS LEGALLY BINDING.

Good Judgment and Good Conduct by Releasee. Releasee warrants and represents that Releasee is capable of using and shall use good judgment with regard to Releasee’s conduct and Releasee’s participation in activities (the “Activities”) and/or Child Watch services (the “Services”) at or via Drakestone Fitness One, LLC DBA (“Doing Business As”) Burn Boot Camp Pensacola (the “Company”). Most of the Activities shall involve some level of physical exertion, sometimes significant physical exertion, and Releasee must and shall decide to participate in Activities only if and to the extent Releasee can reasonably participate and is comfortable doing so. Releasee promises to not participate in Activities or Services if Releasee is uncomfortable or unsure regarding the safety or appropriateness of participating. Releasee will otherwise act in a manner which is respectful and safe toward others during and relating to Activities and Services at or via the Company and when participating in or being present at any Company sponsored, organized, or affiliated event or program and when on property owned or controlled by Company.

Appropriate and Sufficient Health, Medical, Physical, Mental, and Emotional Condition. Releasee warrants and represents that Releasee is in appropriate and sufficient good health and medical, physical, mental, and emotional condition to participate in the Activities that Releasee will be participating in at or via Company and that Releasee has no problems or issues which would endanger Releasee or others due to such participation. Releasee further warrants and represents that Releasee will not utilize the Services except when the child to be cared for is in good health, does not require any medications to be provided while the Services are being utilized, and does not pose an elevated risk toward others, including other children.

Informed Consent and Assumption of Risk. Participating in Activities at or via the Company will by the very nature of said Activities lead to a certain level of physical exertion and physical activity. Releasee is only participating after giving informed consent, including by way of this Agreement. By volunteering to participate in the Activities, Releasee assumes the risk of any negative consequences which may reasonably result from the Activities, including as a result of actions or inactions by the Company, by other activity participants, or by third parties. If Releasee is not aware of the risks which may come by participating in the Activities, Releasee should not participate until and unless Releasee has sought and received information from the Company which allows Releasee to have a fair and reasonable opportunity to know and understand said risks. As to Services, Releasee recognizes and accepts that: Services may be provided by persons who are not child care professionals or otherwise licensed or permitted relating to child care; that the Company is not a licensed or permitted or certified child care facility; the Child Watch services are short-term, drop-in, basic in nature and may only be utilized while Releasee is present on the premises; and even properly monitored children can and sometimes do end up with bumps, bruises, scrapes, and sometimes more serious injuries or conditions.

Communicable Diseases. Participating in Activities at or via the Company will also invariably place Releasee in close proximity with other individuals and in contact with surfaces or areas that may have been handled, touched, or come into contact with other individuals. Due to the nature of the Activities and Services, as well as the participation of other persons, the Company cannot guarantee that recommended social distancing will be followed at all times during the Activities and Services and cannot guarantee that surfaces and other areas or items the Releasee may come in contact with are free of viruses, bacteria, or other contaminants. Releasee acknowledges that cases of the novel coronavirus (“COVID-19”) have been confirmed throughout the United States, including, in Pensacola, FL. By volunteering to participate in the Activities and Services, Releasee appreciates, fully understands, and assumes the risk that Releasee may be exposed to and contract COVID-19 or any other communicable disease, including as a result of actions or inactions by the Company, by other activity participants, or by third parties. If Releasee is not aware of these risks which may come by participating in the Activities, Releasee should not participate until and unless Releasee has sought and received information from the Company which allows Releasee to have a fair and reasonable opportunity to know and understand said risks.

Releasee agrees, represents, and warrants that neither Releasee nor any child that Releasee brings to participate in the Services will participate in Activities or Services or visit the Company’s physical location(s) if he or she (i) is experiencing symptoms of COVID-19, including, without limitation, fever, cough, or shortness of breath or (ii) has a suspected or diagnosed case of COVID-19 or any other communicable disease. Additionally, Releasee agrees, represents, and warrants that neither Releasee nor any child that Releasee brings to participate in the Services will participate in Activities or Services or visit the Company’s physical location(s) if he or she, within the preceding 14 days, has (1) visited an area subject to a CDC Level 3 Travel Health Notice, (2) been exposed to any person who had visited an area subject to a CDC Level 3 Travel Health Notice in the 14 days preceding the exposure, or (3) been exposed to any person who has a suspected or diagnosed case of COVID-19.

Waiver and Release of Liability and Related Covenant. Releasee and anyone who can claim or recover through Releasee hereby agree to waive, relinquish, discharge, release, and covenant not to sue the Company 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 Releasee and anyone who can claim or recover through Releasee may have or come to have arising out of, connected with, or in any way associated with the Activities or Services at or via the Company or with Releasee participating in or being present at any Company sponsored, organized, or affiliated event or program or being on property owned or controlled by Company. Releasee further covenants not to sue or otherwise bring a claim or complaint against Company for any of the matters waived and released herein. This paragraph should not be interpreted to attempt to waive or release rights or claims which, by law, cannot be waived or released in this fashion.

Limitations on Damages in Case of Liability. Should Company somehow be found liable despite this Agreement, Releasee agrees that the maximum damages Company shall be liable for is the total amount Releasee has paid to Company in the preceding twelve (12) months.

Company Indemnified, Defended, and Held Harmless. Releasee hereby agrees to indemnify, defend, and hold harmless the Company, at no cost to Company, as to any claims or causes of action against Company due or related to Releasee’s participation in the Activities or utilization of the Services or related to any action or inaction of Releasee while on Company’s property or while participating or being present in any Company sponsored, organized, or affiliated event or program.

This Agreement’s Interpretation, Severability, Reformation, Completeness, and Finality. The parties agree that the language of this Agreement shall not be interpreted against either party as the “drafter” and that both parties have similar bargaining power here, including since you can choose to join a different organization which assist with exercise and physical conditioning. If any part of this Agreement is found to be void, illegal, or otherwise unenforceable and if the court is able and willing to do so, the parties hereby grant a court with appropriate jurisdiction over the matter to reform or otherwise modify the Agreement if necessary to best accomplish the intent of the Agreement as stated herein. If the Agreement is not so modified, then the offending provision(s) shall be stricken but the remainder of the Agreement shall remain in effect and best interpreted to accomplish the intent of the Agreement as stated herein. The parties affirm that this Agreement is final and complete, and supersedes any other information which contradicts this Agreement, and cannot be amended except by further written agreement of the parties which is clearly intended to amend this Agreement.

Resolution of Disputes. Company does not expect to have any disputes with Releasees, but this issue is addressed in case that does occur. Should there be any disputes between regarding this Agreement or any other aspect of the relationship between Releasee and Company which results in a legal or quasi-legal action being initiated, Tennessee laws and rules shall apply to the extent allowable. Jurisdiction and venue for any legal or quasi-legal action shall only be with a state court in Pensacola, Florida. Each party will bear its own court costs and attorneys’ fees except that if there is a dispute regarding Releasee’s non-payment of costs or fees or dues to Company, the prevailing party shall recover its legal costs and fees relating to that dispute, including attorneys’ fees and including any costs of collection, whether pre-litigation or otherwise.

Releasee’s Agent Executing on Behalf of Releasee. If the Releasee is unable to execute this document of his or her own accord for whatever reason, and it is instead being executed by someone on behalf of the Releasee (the “Releasee’s Agent”), the Releasee’s Agent hereby warrants, represents, and swears that (s)he has the authority to execute this legally binding agreement on behalf of the Releasee and that Company absolutely and materially relies on that warranty, representation, and sworn indication.

THIS IS A BINDING LEGAL AGREEMENT

 

Releasee’s Signature


Date of Signature April 20, 2026

 

*PARENT/GUARDIAN MUST COMPLETE THE SECTCTION BELOW ONLY IF PARTICIPANT IS A MINOR / UNDER THE AGE OF 18
*If Releasee is a minor or unable to sign / date, Releasee’s name must still be written above and the below completed:


Burn Boot Camp Pensacola  pensacola@burnbootcamp.com

First Participant's Name
First Name*
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
Information

Burn Boot Camp Client PAR-Q and MindBody Profile Set Up
Please answer each question accurately and honestly. 

1. Has any healthcare professional ever said that you have a heart condition and that you should only engage in physical activity as recommended by a doctor?*
No
Yes
2. Do you feel pain in your chest when you engage in physical activity?*
No
Yes
7. Do you know of any other reason why you should not engage in physical activity?*
No
Yes
3. In the past month, have you had any chest pain when you were not doing physical activity?*
No
Yes
4. Do you lose your balance or ever lose consciousness, even if just briefly?*
No
Yes
6. Is your doctor currently prescribing medications or any treatment regimen related to your blood pressure or heart condition?*
No
Yes
Have you been pregnant at any point within the last year and/or given birth?
5. Do you have a bone or joint problem (for example, back, knee, or hip) that could be made worse by a change in your physical activity?*
No
Yes

PLEASE COMPLETE THE FOLLOWING QUESTIONS ONLY IF YOU WERE PREGNANT WITHIN THE LAST YEAR:

Are you currently pregnant?
Are you less than 6 weeks post-partum?

*If you are less than 6 weeks post-partum, a doctor's clearance note is required prior to participating in any workout at Burn Boot Camp Pensacola* 

First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

Burn Boot Camp Client PAR-Q and MindBody Profile Set Up
Please answer each question accurately and honestly. 

1. Has any healthcare professional ever said that you have a heart condition and that you should only engage in physical activity as recommended by a doctor?*
No
Yes
2. Do you feel pain in your chest when you engage in physical activity?*
No
Yes
7. Do you know of any other reason why you should not engage in physical activity?*
No
Yes
3. In the past month, have you had any chest pain when you were not doing physical activity?*
No
Yes
4. Do you lose your balance or ever lose consciousness, even if just briefly?*
No
Yes
6. Is your doctor currently prescribing medications or any treatment regimen related to your blood pressure or heart condition?*
No
Yes
Have you been pregnant at any point within the last year and/or given birth?
5. Do you have a bone or joint problem (for example, back, knee, or hip) that could be made worse by a change in your physical activity?*
No
Yes

PLEASE COMPLETE THE FOLLOWING QUESTIONS ONLY IF YOU WERE PREGNANT WITHIN THE LAST YEAR:

Are you currently pregnant?
Are you less than 6 weeks post-partum?

*If you are less than 6 weeks post-partum, a doctor's clearance note is required prior to participating in any workout at Burn Boot Camp Pensacola* 

Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

Burn Boot Camp Client PAR-Q and MindBody Profile Set Up
Please answer each question accurately and honestly. 

1. Has any healthcare professional ever said that you have a heart condition and that you should only engage in physical activity as recommended by a doctor?*
No
Yes
2. Do you feel pain in your chest when you engage in physical activity?*
No
Yes
7. Do you know of any other reason why you should not engage in physical activity?*
No
Yes
3. In the past month, have you had any chest pain when you were not doing physical activity?*
No
Yes
4. Do you lose your balance or ever lose consciousness, even if just briefly?*
No
Yes
6. Is your doctor currently prescribing medications or any treatment regimen related to your blood pressure or heart condition?*
No
Yes
Have you been pregnant at any point within the last year and/or given birth?
5. Do you have a bone or joint problem (for example, back, knee, or hip) that could be made worse by a change in your physical activity?*
No
Yes

PLEASE COMPLETE THE FOLLOWING QUESTIONS ONLY IF YOU WERE PREGNANT WITHIN THE LAST YEAR:

Are you currently pregnant?
Are you less than 6 weeks post-partum?

*If you are less than 6 weeks post-partum, a doctor's clearance note is required prior to participating in any workout at Burn Boot Camp Pensacola* 

Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

Burn Boot Camp Client PAR-Q and MindBody Profile Set Up
Please answer each question accurately and honestly. 

1. Has any healthcare professional ever said that you have a heart condition and that you should only engage in physical activity as recommended by a doctor?*
No
Yes
2. Do you feel pain in your chest when you engage in physical activity?*
No
Yes
7. Do you know of any other reason why you should not engage in physical activity?*
No
Yes
3. In the past month, have you had any chest pain when you were not doing physical activity?*
No
Yes
4. Do you lose your balance or ever lose consciousness, even if just briefly?*
No
Yes
6. Is your doctor currently prescribing medications or any treatment regimen related to your blood pressure or heart condition?*
No
Yes
Have you been pregnant at any point within the last year and/or given birth?
5. Do you have a bone or joint problem (for example, back, knee, or hip) that could be made worse by a change in your physical activity?*
No
Yes

PLEASE COMPLETE THE FOLLOWING QUESTIONS ONLY IF YOU WERE PREGNANT WITHIN THE LAST YEAR:

Are you currently pregnant?
Are you less than 6 weeks post-partum?

*If you are less than 6 weeks post-partum, a doctor's clearance note is required prior to participating in any workout at Burn Boot Camp Pensacola* 

Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

Burn Boot Camp Client PAR-Q and MindBody Profile Set Up
Please answer each question accurately and honestly. 

1. Has any healthcare professional ever said that you have a heart condition and that you should only engage in physical activity as recommended by a doctor?*
No
Yes
2. Do you feel pain in your chest when you engage in physical activity?*
No
Yes
7. Do you know of any other reason why you should not engage in physical activity?*
No
Yes
3. In the past month, have you had any chest pain when you were not doing physical activity?*
No
Yes
4. Do you lose your balance or ever lose consciousness, even if just briefly?*
No
Yes
6. Is your doctor currently prescribing medications or any treatment regimen related to your blood pressure or heart condition?*
No
Yes
Have you been pregnant at any point within the last year and/or given birth?
5. Do you have a bone or joint problem (for example, back, knee, or hip) that could be made worse by a change in your physical activity?*
No
Yes

PLEASE COMPLETE THE FOLLOWING QUESTIONS ONLY IF YOU WERE PREGNANT WITHIN THE LAST YEAR:

Are you currently pregnant?
Are you less than 6 weeks post-partum?

*If you are less than 6 weeks post-partum, a doctor's clearance note is required prior to participating in any workout at Burn Boot Camp Pensacola* 

Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

Burn Boot Camp Client PAR-Q and MindBody Profile Set Up
Please answer each question accurately and honestly. 

1. Has any healthcare professional ever said that you have a heart condition and that you should only engage in physical activity as recommended by a doctor?*
No
Yes
2. Do you feel pain in your chest when you engage in physical activity?*
No
Yes
7. Do you know of any other reason why you should not engage in physical activity?*
No
Yes
3. In the past month, have you had any chest pain when you were not doing physical activity?*
No
Yes
4. Do you lose your balance or ever lose consciousness, even if just briefly?*
No
Yes
6. Is your doctor currently prescribing medications or any treatment regimen related to your blood pressure or heart condition?*
No
Yes
Have you been pregnant at any point within the last year and/or given birth?
5. Do you have a bone or joint problem (for example, back, knee, or hip) that could be made worse by a change in your physical activity?*
No
Yes

PLEASE COMPLETE THE FOLLOWING QUESTIONS ONLY IF YOU WERE PREGNANT WITHIN THE LAST YEAR:

Are you currently pregnant?
Are you less than 6 weeks post-partum?

*If you are less than 6 weeks post-partum, a doctor's clearance note is required prior to participating in any workout at Burn Boot Camp Pensacola* 

Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

Burn Boot Camp Client PAR-Q and MindBody Profile Set Up
Please answer each question accurately and honestly. 

1. Has any healthcare professional ever said that you have a heart condition and that you should only engage in physical activity as recommended by a doctor?*
No
Yes
2. Do you feel pain in your chest when you engage in physical activity?*
No
Yes
7. Do you know of any other reason why you should not engage in physical activity?*
No
Yes
3. In the past month, have you had any chest pain when you were not doing physical activity?*
No
Yes
4. Do you lose your balance or ever lose consciousness, even if just briefly?*
No
Yes
6. Is your doctor currently prescribing medications or any treatment regimen related to your blood pressure or heart condition?*
No
Yes
Have you been pregnant at any point within the last year and/or given birth?
5. Do you have a bone or joint problem (for example, back, knee, or hip) that could be made worse by a change in your physical activity?*
No
Yes

PLEASE COMPLETE THE FOLLOWING QUESTIONS ONLY IF YOU WERE PREGNANT WITHIN THE LAST YEAR:

Are you currently pregnant?
Are you less than 6 weeks post-partum?

*If you are less than 6 weeks post-partum, a doctor's clearance note is required prior to participating in any workout at Burn Boot Camp Pensacola* 

Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

Burn Boot Camp Client PAR-Q and MindBody Profile Set Up
Please answer each question accurately and honestly. 

1. Has any healthcare professional ever said that you have a heart condition and that you should only engage in physical activity as recommended by a doctor?*
No
Yes
2. Do you feel pain in your chest when you engage in physical activity?*
No
Yes
7. Do you know of any other reason why you should not engage in physical activity?*
No
Yes
3. In the past month, have you had any chest pain when you were not doing physical activity?*
No
Yes
4. Do you lose your balance or ever lose consciousness, even if just briefly?*
No
Yes
6. Is your doctor currently prescribing medications or any treatment regimen related to your blood pressure or heart condition?*
No
Yes
Have you been pregnant at any point within the last year and/or given birth?
5. Do you have a bone or joint problem (for example, back, knee, or hip) that could be made worse by a change in your physical activity?*
No
Yes

PLEASE COMPLETE THE FOLLOWING QUESTIONS ONLY IF YOU WERE PREGNANT WITHIN THE LAST YEAR:

Are you currently pregnant?
Are you less than 6 weeks post-partum?

*If you are less than 6 weeks post-partum, a doctor's clearance note is required prior to participating in any workout at Burn Boot Camp Pensacola* 

Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

Burn Boot Camp Client PAR-Q and MindBody Profile Set Up
Please answer each question accurately and honestly. 

1. Has any healthcare professional ever said that you have a heart condition and that you should only engage in physical activity as recommended by a doctor?*
No
Yes
2. Do you feel pain in your chest when you engage in physical activity?*
No
Yes
7. Do you know of any other reason why you should not engage in physical activity?*
No
Yes
3. In the past month, have you had any chest pain when you were not doing physical activity?*
No
Yes
4. Do you lose your balance or ever lose consciousness, even if just briefly?*
No
Yes
6. Is your doctor currently prescribing medications or any treatment regimen related to your blood pressure or heart condition?*
No
Yes
Have you been pregnant at any point within the last year and/or given birth?
5. Do you have a bone or joint problem (for example, back, knee, or hip) that could be made worse by a change in your physical activity?*
No
Yes

PLEASE COMPLETE THE FOLLOWING QUESTIONS ONLY IF YOU WERE PREGNANT WITHIN THE LAST YEAR:

Are you currently pregnant?
Are you less than 6 weeks post-partum?

*If you are less than 6 weeks post-partum, a doctor's clearance note is required prior to participating in any workout at Burn Boot Camp Pensacola* 

Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

Burn Boot Camp Client PAR-Q and MindBody Profile Set Up
Please answer each question accurately and honestly. 

1. Has any healthcare professional ever said that you have a heart condition and that you should only engage in physical activity as recommended by a doctor?*
No
Yes
2. Do you feel pain in your chest when you engage in physical activity?*
No
Yes
7. Do you know of any other reason why you should not engage in physical activity?*
No
Yes
3. In the past month, have you had any chest pain when you were not doing physical activity?*
No
Yes
4. Do you lose your balance or ever lose consciousness, even if just briefly?*
No
Yes
6. Is your doctor currently prescribing medications or any treatment regimen related to your blood pressure or heart condition?*
No
Yes
Have you been pregnant at any point within the last year and/or given birth?
5. Do you have a bone or joint problem (for example, back, knee, or hip) that could be made worse by a change in your physical activity?*
No
Yes

PLEASE COMPLETE THE FOLLOWING QUESTIONS ONLY IF YOU WERE PREGNANT WITHIN THE LAST YEAR:

Are you currently pregnant?
Are you less than 6 weeks post-partum?

*If you are less than 6 weeks post-partum, a doctor's clearance note is required prior to participating in any workout at Burn Boot Camp Pensacola* 

Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
Camp Time:
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.


By signing below the parent or court-appointed legal guardian agrees that they are also 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*
Date of Birth
Information

Burn Boot Camp Client PAR-Q and MindBody Profile Set Up
Please answer each question accurately and honestly. 

1. Has any healthcare professional ever said that you have a heart condition and that you should only engage in physical activity as recommended by a doctor?*
No
Yes
2. Do you feel pain in your chest when you engage in physical activity?*
No
Yes
7. Do you know of any other reason why you should not engage in physical activity?*
No
Yes
3. In the past month, have you had any chest pain when you were not doing physical activity?*
No
Yes
4. Do you lose your balance or ever lose consciousness, even if just briefly?*
No
Yes
6. Is your doctor currently prescribing medications or any treatment regimen related to your blood pressure or heart condition?*
No
Yes
Have you been pregnant at any point within the last year and/or given birth?
5. Do you have a bone or joint problem (for example, back, knee, or hip) that could be made worse by a change in your physical activity?*
No
Yes

PLEASE COMPLETE THE FOLLOWING QUESTIONS ONLY IF YOU WERE PREGNANT WITHIN THE LAST YEAR:

Are you currently pregnant?
Are you less than 6 weeks post-partum?

*If you are less than 6 weeks post-partum, a doctor's clearance note is required prior to participating in any workout at Burn Boot Camp Pensacola* 

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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