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ADULT participants (18 yrs & Older)
who are financially responsible for their training, type N/A in this section.
Participant Name
Date of Birth
Parent/Guardian Name
Email Address
Address/City
Phone
What Class Will You Be Attending?
*
JR Speed
Elite (HS)
Goal Keep
Adult Fit
Are there any medical concerns within the past 5 years we should be aware of?
Have you been released by a physican to participate in physical activity
*
Yes
No
N/A
I declare that the information I’ve provided above is accurate & complete
I hereby agree to inform instructors and CoreSpeed Gym of any medical concerns. I understand that photos/videos may be taken during this activity and may be used for promotional material for CoreSpeed Gym's programs and you hereby agree to such use. I hereby acknowledge that the use of the services, equipment or premises of CoreSpeed Gym involves risks of injury to persons and property, including but not limited to injuries arising from use of exercise equipment and machines; injures arising from participation in supervised or unsupervised activities or programs at CoreSpeed Gym; injuries and medical disorders arising from exercising at CoreSpeed Gym, such as heat stress, sprains, broken bones, and torn muscles and ligaments, among others; and accidental injuries occurring anywhere at CoreSpeed Gym. You hereby assume full responsibility for you or your child’s participation. Â
Parent/Guardian Signature (Must be 18yrs or older)
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