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WELCOME TO
2ADDICTIVE LIFESTYLES TRAINING CENTRE

Waiver & PRE-QUESTIONAIRE
Please take a few minutes to answer all questions.

WAIVER

With the approval of 2addictive Lifestyles, I acknowledge, understand & am aware that I have voluntarily chosen to participate in the training activities provided by 2addictive Lifestyles.

I acknowledge there are inherent risks in all aspects of physical training & that I have been informed of the possible strenuous nature of the training & the potential for undesirable physiological results including, but not limited to, abnormal blood pressure, muscle soreness, fainting, heart attack &/or death.

I acknowledge that the training may involve high-exertion activities, including but not limited to lifting weights, strenuous bodyweight exercises, running and using training apparatus.

I acknowledge that if I have any health issues with the training provided, I can choose to not participate.

I acknowledge that should I feel ill in any way, including lightheaded, faint, dizzy, nauseated, or experiencing pain or discomfort, I am to stop the activity and inform my trainer.

I give the staff at 2addictive Lifestyles permission to seek medical help, including emergency services and I am responsible for any expenses incurred.

I agree to WAIVE ANY AND ALL CLAIMS that I have or may have in the future against 2addictive Lifestyles & its directors, officers, employees, agents, volunteers & independent contractors (all of whom are hereinafter collectively referred to as "the Releasees").

I agree to RELEASE THE RELEASEES from any & all liability for any loss, damage, injury or expense that I may suffer, or that my next of kin may suffer as a result of my participation in the programs, activities & services provided by 2addictive Lifestyles, due to any cause whatsoever including negligence, breach of contract, or breach of any statutory or other duty of care.

I agree to HOLD HARMLESS & INDEMNIFY THE RELEASEES from any and all liability for any damage to the property of, or personal injury to, any third party, resulting from my participation in any program, activity or service provided by the Releasees.

I agree to fill in a Pre-questionnaire when signing up which will release personal information, including health information. In some cases, the responses you give will require that you get medical guidance before exercising. You acknowledge that pre-exercise or other screening is no substitute for medical advice & does not guarantee against injury or death. You promise that the information you give us will be true & accurate & not misleading in any way. We may suspend or cancel your membership if we have reason to suspect that you have not complied with any part of this clause.

I agree to allow 2addictive Lifestyles, its employees & volunteers to use picture(s), film &/or likeness of me for advertising purposes. I agree that If I want to take picture(s), film &/or likeness I must obtain permission from 2addictive Lifestyles

Participant is under 18:
If I am signing on behalf of someone who is under 18 years old, I must be a parent or guardian. I give full permission for any person connected with 2Addictive Lifestyles to administer first aid, to call for medical and or surgical care for the child & to transport the child to a medical facility deemed necessary for the well-being of the child. I am aware of the risks, dangers & injuries associated in participating in any activity.

If you have answered yes to any of the above, please consult a medical professional and get clearance before starting.

OR I warrant that I am physically and mentally well enough to proceed with training at 2Addictive Lifestyles. I self-clear myself/ or of the above conditions.

Date: January 31, 2025

First Participant's Name

First Name*

Last Name*

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

Please specify what you are at the facility for (e.g., training session, event, class, etc.):

How did you hear about us?

It is our duty of care that we ask medical questions before commencing any activity in 2addictive lifestyles.
Please answer with a yes or no – PARENT OR GUARDIAN MUST ANSWER QUESTIONS FOR UNDER 18 PARTICIPANT.

Medical:

1) Has a family member suffered from heart disease, stroke, elevated cholesterol or sudden death?*
No
Yes
2) Are you on any prescribed medication, if so, would this effect you doing physical exercise?*
No
Yes
3) Have you been hospitalised recently?*
No
Yes
4) Are you pregnant or Have you given birth in the last 6 weeks?*
No
Yes
5) Do you have any infections or infectious diseases?*
No
Yes
6) Do you have any / had any medical condition? E.g., asthma, stroke, heart condition?*
No
Yes

If YES please explain
7) Do you suffer from any, Chest pains, muscular pains, asthma, dizziness/fainting?*
No
Yes
8) Do you have Pain or Major injuries? E.g.; Neck, Back, Knees, Ankles, etc. *
No
Yes

IF YES please explain
First Participant's Signature*
Second Participant's Name

First Name*

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

Please specify what you are at the facility for (e.g., training session, event, class, etc.):

How did you hear about us?

It is our duty of care that we ask medical questions before commencing any activity in 2addictive lifestyles.
Please answer with a yes or no – PARENT OR GUARDIAN MUST ANSWER QUESTIONS FOR UNDER 18 PARTICIPANT.

Medical:

1) Has a family member suffered from heart disease, stroke, elevated cholesterol or sudden death?*
No
Yes
2) Are you on any prescribed medication, if so, would this effect you doing physical exercise?*
No
Yes
3) Have you been hospitalised recently?*
No
Yes
4) Are you pregnant or Have you given birth in the last 6 weeks?*
No
Yes
5) Do you have any infections or infectious diseases?*
No
Yes
6) Do you have any / had any medical condition? E.g., asthma, stroke, heart condition?*
No
Yes

If YES please explain
7) Do you suffer from any, Chest pains, muscular pains, asthma, dizziness/fainting?*
No
Yes
8) Do you have Pain or Major injuries? E.g.; Neck, Back, Knees, Ankles, etc. *
No
Yes

IF YES please explain
Third Participant's Name

First Name*

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

Please specify what you are at the facility for (e.g., training session, event, class, etc.):

How did you hear about us?

It is our duty of care that we ask medical questions before commencing any activity in 2addictive lifestyles.
Please answer with a yes or no – PARENT OR GUARDIAN MUST ANSWER QUESTIONS FOR UNDER 18 PARTICIPANT.

Medical:

1) Has a family member suffered from heart disease, stroke, elevated cholesterol or sudden death?*
No
Yes
2) Are you on any prescribed medication, if so, would this effect you doing physical exercise?*
No
Yes
3) Have you been hospitalised recently?*
No
Yes
4) Are you pregnant or Have you given birth in the last 6 weeks?*
No
Yes
5) Do you have any infections or infectious diseases?*
No
Yes
6) Do you have any / had any medical condition? E.g., asthma, stroke, heart condition?*
No
Yes

If YES please explain
7) Do you suffer from any, Chest pains, muscular pains, asthma, dizziness/fainting?*
No
Yes
8) Do you have Pain or Major injuries? E.g.; Neck, Back, Knees, Ankles, etc. *
No
Yes

IF YES please explain
Fourth Participant's Name

First Name*

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

Please specify what you are at the facility for (e.g., training session, event, class, etc.):

How did you hear about us?

It is our duty of care that we ask medical questions before commencing any activity in 2addictive lifestyles.
Please answer with a yes or no – PARENT OR GUARDIAN MUST ANSWER QUESTIONS FOR UNDER 18 PARTICIPANT.

Medical:

1) Has a family member suffered from heart disease, stroke, elevated cholesterol or sudden death?*
No
Yes
2) Are you on any prescribed medication, if so, would this effect you doing physical exercise?*
No
Yes
3) Have you been hospitalised recently?*
No
Yes
4) Are you pregnant or Have you given birth in the last 6 weeks?*
No
Yes
5) Do you have any infections or infectious diseases?*
No
Yes
6) Do you have any / had any medical condition? E.g., asthma, stroke, heart condition?*
No
Yes

If YES please explain
7) Do you suffer from any, Chest pains, muscular pains, asthma, dizziness/fainting?*
No
Yes
8) Do you have Pain or Major injuries? E.g.; Neck, Back, Knees, Ankles, etc. *
No
Yes

IF YES please explain
Fifth Participant's Name

First Name*

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

Please specify what you are at the facility for (e.g., training session, event, class, etc.):

How did you hear about us?

It is our duty of care that we ask medical questions before commencing any activity in 2addictive lifestyles.
Please answer with a yes or no – PARENT OR GUARDIAN MUST ANSWER QUESTIONS FOR UNDER 18 PARTICIPANT.

Medical:

1) Has a family member suffered from heart disease, stroke, elevated cholesterol or sudden death?*
No
Yes
2) Are you on any prescribed medication, if so, would this effect you doing physical exercise?*
No
Yes
3) Have you been hospitalised recently?*
No
Yes
4) Are you pregnant or Have you given birth in the last 6 weeks?*
No
Yes
5) Do you have any infections or infectious diseases?*
No
Yes
6) Do you have any / had any medical condition? E.g., asthma, stroke, heart condition?*
No
Yes

If YES please explain
7) Do you suffer from any, Chest pains, muscular pains, asthma, dizziness/fainting?*
No
Yes
8) Do you have Pain or Major injuries? E.g.; Neck, Back, Knees, Ankles, etc. *
No
Yes

IF YES please explain
Sixth Participant's Name

First Name*

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

Please specify what you are at the facility for (e.g., training session, event, class, etc.):

How did you hear about us?

It is our duty of care that we ask medical questions before commencing any activity in 2addictive lifestyles.
Please answer with a yes or no – PARENT OR GUARDIAN MUST ANSWER QUESTIONS FOR UNDER 18 PARTICIPANT.

Medical:

1) Has a family member suffered from heart disease, stroke, elevated cholesterol or sudden death?*
No
Yes
2) Are you on any prescribed medication, if so, would this effect you doing physical exercise?*
No
Yes
3) Have you been hospitalised recently?*
No
Yes
4) Are you pregnant or Have you given birth in the last 6 weeks?*
No
Yes
5) Do you have any infections or infectious diseases?*
No
Yes
6) Do you have any / had any medical condition? E.g., asthma, stroke, heart condition?*
No
Yes

If YES please explain
7) Do you suffer from any, Chest pains, muscular pains, asthma, dizziness/fainting?*
No
Yes
8) Do you have Pain or Major injuries? E.g.; Neck, Back, Knees, Ankles, etc. *
No
Yes

IF YES please explain
Seventh Participant's Name

First Name*

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

Please specify what you are at the facility for (e.g., training session, event, class, etc.):

How did you hear about us?

It is our duty of care that we ask medical questions before commencing any activity in 2addictive lifestyles.
Please answer with a yes or no – PARENT OR GUARDIAN MUST ANSWER QUESTIONS FOR UNDER 18 PARTICIPANT.

Medical:

1) Has a family member suffered from heart disease, stroke, elevated cholesterol or sudden death?*
No
Yes
2) Are you on any prescribed medication, if so, would this effect you doing physical exercise?*
No
Yes
3) Have you been hospitalised recently?*
No
Yes
4) Are you pregnant or Have you given birth in the last 6 weeks?*
No
Yes
5) Do you have any infections or infectious diseases?*
No
Yes
6) Do you have any / had any medical condition? E.g., asthma, stroke, heart condition?*
No
Yes

If YES please explain
7) Do you suffer from any, Chest pains, muscular pains, asthma, dizziness/fainting?*
No
Yes
8) Do you have Pain or Major injuries? E.g.; Neck, Back, Knees, Ankles, etc. *
No
Yes

IF YES please explain
Eighth Participant's Name

First Name*

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

Please specify what you are at the facility for (e.g., training session, event, class, etc.):

How did you hear about us?

It is our duty of care that we ask medical questions before commencing any activity in 2addictive lifestyles.
Please answer with a yes or no – PARENT OR GUARDIAN MUST ANSWER QUESTIONS FOR UNDER 18 PARTICIPANT.

Medical:

1) Has a family member suffered from heart disease, stroke, elevated cholesterol or sudden death?*
No
Yes
2) Are you on any prescribed medication, if so, would this effect you doing physical exercise?*
No
Yes
3) Have you been hospitalised recently?*
No
Yes
4) Are you pregnant or Have you given birth in the last 6 weeks?*
No
Yes
5) Do you have any infections or infectious diseases?*
No
Yes
6) Do you have any / had any medical condition? E.g., asthma, stroke, heart condition?*
No
Yes

If YES please explain
7) Do you suffer from any, Chest pains, muscular pains, asthma, dizziness/fainting?*
No
Yes
8) Do you have Pain or Major injuries? E.g.; Neck, Back, Knees, Ankles, etc. *
No
Yes

IF YES please explain
Ninth Participant's Name

First Name*

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

Please specify what you are at the facility for (e.g., training session, event, class, etc.):

How did you hear about us?

It is our duty of care that we ask medical questions before commencing any activity in 2addictive lifestyles.
Please answer with a yes or no – PARENT OR GUARDIAN MUST ANSWER QUESTIONS FOR UNDER 18 PARTICIPANT.

Medical:

1) Has a family member suffered from heart disease, stroke, elevated cholesterol or sudden death?*
No
Yes
2) Are you on any prescribed medication, if so, would this effect you doing physical exercise?*
No
Yes
3) Have you been hospitalised recently?*
No
Yes
4) Are you pregnant or Have you given birth in the last 6 weeks?*
No
Yes
5) Do you have any infections or infectious diseases?*
No
Yes
6) Do you have any / had any medical condition? E.g., asthma, stroke, heart condition?*
No
Yes

If YES please explain
7) Do you suffer from any, Chest pains, muscular pains, asthma, dizziness/fainting?*
No
Yes
8) Do you have Pain or Major injuries? E.g.; Neck, Back, Knees, Ankles, etc. *
No
Yes

IF YES please explain
Tenth Participant's Name

First Name*

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

Please specify what you are at the facility for (e.g., training session, event, class, etc.):

How did you hear about us?

It is our duty of care that we ask medical questions before commencing any activity in 2addictive lifestyles.
Please answer with a yes or no – PARENT OR GUARDIAN MUST ANSWER QUESTIONS FOR UNDER 18 PARTICIPANT.

Medical:

1) Has a family member suffered from heart disease, stroke, elevated cholesterol or sudden death?*
No
Yes
2) Are you on any prescribed medication, if so, would this effect you doing physical exercise?*
No
Yes
3) Have you been hospitalised recently?*
No
Yes
4) Are you pregnant or Have you given birth in the last 6 weeks?*
No
Yes
5) Do you have any infections or infectious diseases?*
No
Yes
6) Do you have any / had any medical condition? E.g., asthma, stroke, heart condition?*
No
Yes

If YES please explain
7) Do you suffer from any, Chest pains, muscular pains, asthma, dizziness/fainting?*
No
Yes
8) Do you have Pain or Major injuries? E.g.; Neck, Back, Knees, Ankles, etc. *
No
Yes

IF YES please explain
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*
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*
Parent or Guardian's Information

Please specify what you are at the facility for (e.g., training session, event, class, etc.):

How did you hear about us?

It is our duty of care that we ask medical questions before commencing any activity in 2addictive lifestyles.
Please answer with a yes or no – PARENT OR GUARDIAN MUST ANSWER QUESTIONS FOR UNDER 18 PARTICIPANT.

Medical:

1) Has a family member suffered from heart disease, stroke, elevated cholesterol or sudden death?*
No
Yes
2) Are you on any prescribed medication, if so, would this effect you doing physical exercise?*
No
Yes
3) Have you been hospitalised recently?*
No
Yes
4) Are you pregnant or Have you given birth in the last 6 weeks?*
No
Yes
5) Do you have any infections or infectious diseases?*
No
Yes
6) Do you have any / had any medical condition? E.g., asthma, stroke, heart condition?*
No
Yes

If YES please explain
7) Do you suffer from any, Chest pains, muscular pains, asthma, dizziness/fainting?*
No
Yes
8) Do you have Pain or Major injuries? E.g.; Neck, Back, Knees, Ankles, etc. *
No
Yes

IF YES please explain
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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