LIABILITY WAIVER

Name

First Name

Last Name

Email

Phone

(###)

###

####

Date of Birth

MM

DD

YYYY

Are you pregnant? Or have you recently given birth?

If yes, please elaborate. How far along are you?

Are you currently suffering from a medical condition, illness, or injury?

If yes, please elaborate:

Initials

Today's Date

MM

DD

YYYY

I declare that the information that I have provided here is accurate and complete.

Yes

NOTICE: PLEASE CONSULT YOUR PHYSICIAN BEFORE BEGINNING ANY EXERCISE, FITNESS, DIET OR NUTRITION PROGRAM, ESPECIALLY IF YOU ARE PREGNANT, OR HAVE PRE-EXISTING CHRONIC HEALTH CONDITIONS. YOUR USE OF THIS VIDEO IS SOLELY AT YOUR OWN RISK.