Health Waiver

Central Penn Krav Maga LLC

First Name

Last Name

Email Address

Emergency Contact Name:

Date of Birth

Emergency Contact Phone Number:

Do you have a doctor’s permit to participate in intense physical activities?

Yes

Do you have any physical or mental limitations that may interfere with training here?

Yes

Initials

Today's Date

I declare that the info I’ve provided is accurate & complete

Because physical exercise and participating in our programs can be strenuous and subject to risk of illness, serious injury or death, Central Penn Krav Maga LLC urges you to obtain a physical examination from a doctor before participating in any training activity. You (each client, guest, and all participating family members) agree that if you engage in any physical exercise or activity, or use any gym amenity on the premises or off premises, including any sponsored gym event, you do so entirely at your own risk. You agree that you are voluntarily participating in these activities and use of these facilities and premises and assume all risks of injury, illness, or death. We are also not responsible for any loss of your personal property. This waiver and release of liability includes, without limitation, all injuries which may occur as a result of: 1) your use of all amenities and equipment in the facility and your participation in any activity, class, program, personal training or instruction;, 2) the sudden and unforeseen malfunctioning of any equipment; 3) our instruction, training, supervision; 4) your slipping and/or falling while in the building, or on the premises, including adjacent sidewalks and parking areas; 5) contact with other participants; 6) the effects of the weather, including high heat and/or humidity; and all other such risks being both known and unforeseen by me. I/We hereby acknowledge my responsibility in communicating any physical and psychological concerns that might conflict with participation in activity. I/We acknowledge that I am physically fit and mentally capable of performing the physical activity I choose to participate in. After having read this waiver and knowing these facts, and in consideration of acceptance of my participation and Central Penn Krav Maga LLC furnishing services to me, I agree, for myself and anyone entitled to act on my behalf, to HOLD HARMLESS, WAIVE AND RELEASE Central Penn Krav Maga LLC, its owner, its officers, agents, coaches, employees, organizers, representatives, and successors from any and all claims or causes of action and you agree to voluntarily give up or waive any right that you may otherwise have to bring a legal action against the facility for personal injury or property damage. To the extent that statute or case law does not prohibit releases for negligence, this release is also for negligence on the part of the facility, its agents, coaches and employees.

I agree to the terms & conditions

Your Signature

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Welcome to Central Penn Krav Maga

717-715-6425

Health Waiver