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Small Group Wavier

Questions marked with a * are required

HeartContact Information

First Name

Last Name

Phone

Emergency Contact Name & Number

Do you have any underline health Issues that may impair your ability to partake in physical activity

Yes

No

List any Underline Health Issue effecting/ pertaining to your health, or that May impair your ability to workout.

Heart

Lungs

Diabetes

High Blood Pressure

Other

N/A

I understand that if I have the following symptoms: sore throat, cough, chills, body aches for unknown reasons, shortness of breath for unknown reasons, loss of smell, loss of taste, fever at or greater than 100 degrees Fahrenheit then I will not enter the facility. That includes, but not limited to if I come in contact with someone that has tested positive of COVID19 virus or shows any of the symptoms listed above. I agree that I will do my best to not expose the facility to any contamination.

I agree

I disagree

I understand that all monthly sessions are due on the 8th of each month. Session will not role over. After a month, a new monthly session will begin.

I agree

I disagree

I understand that I am unable to make my monthly payment on time, I will receive an invoicein the amount of $15 for each day that I was present.

I agree

I disagree

As a participant of The Gr8s Health and Wellness Corp, I understand that physical exercise can be strenuous and subject to risk of serious injury. You are urged to obtain a physical examination from a doctor before participating in any exercise activity. I agree that if I engage in any physical exercise or activity, I do so entirely at my own risk. I hereby release and forever discharge The Gr8s Health & Wellness Corp, their respective management, partners, agents, contractors, employees, volunteers, and interns (whether within scope of their employment or not) from any claims, demands, or cause of action relating to or arising from presence or participation in The Gr8s Health & Wellness program, which may result in injury to me or even death. I intend this release to bind my heirs, executors, assigns, administrators, personal representative, and myself.

I agree to the binding contract

I disagree to this binding contract

Electronic Signature : By typing you name you are saying that you adhere to all the information on this form.

First & Last Name

Date

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