Sign-up Form

Please fill out the sign up form to receive your free into CrossFit session!

Full Name:
Email Address:
Address:
City:
State:
Zip:
Primary Phone:
Alternate Phone:
Date of Birth:	(MM/DD/YYYY)
Body Weight:
Height:
Sex:	Male Female
Fitness Goal (explain):
Private Physician:
Phone:
Emergency Contact and Phone:
Your Company:
Email (required):
Referred By:	Select Backpage.com Craig's List Google Search Yahoo Search Current Client (provide name) Other Search Engine Other (explain)

I, have read the following waiver, understand, and agree to its contents.

THE FOLLOWING IS A WAIVER. READ IT BEFORE SIGNING. BY AFFIXING MY SIGNATURE TO THIS DOCUMENT, I ATTEST, CONTRACT, UNDERSTAND AND AGREE THAT I AM TO BE LEGALLY BOUND BY ITS CONTENTS. I hereby stipulate and agree: That I realize the risks of cardiovascular exercise, weight lifting, weight training and/or body building, and I am fully aware of the possibility of malfunctions of equipment.

I, therefore fully understand and I am mindful of the serious consequences which might result due to my involvement in cardiovascular exercise, weight lifting, weight training and/or body building while training with Desert CrossFit , and based on that understanding, as set forth in this paragraph, I voluntarily assume any and all risk of loss, damage or injury of any kind whatsoever from my use of any and all of the equipment of Desert CrossFit, and further and with full knowledge of the consequences (i.e. that I am waiving my right to sue) expressly waive the part of Desert CrossFit , and the operator of Desert CrossFit, and from my use of Desert CrossFit' equipment and/or facilities. That I am physically sound and have medical approval to proceed with a normal routine of exercise. That all exercises shall be undertaken by me at my sole risk. That I am in good health and have no physical conditions that would be aggravated by my involvement in cardiovascular exercise, weight lifting, weight training and/or body building, nor do I have any physical limitations that would preclude said involvement. I also release Desert CrossFit and its contractors (the personal trainers) from liability for their negligence, defective equipment, injuries from dangerous conditions of property, etc.

HAVING READ THE ABOVE TERMS AND INTENDING TO BE LEGALLY BOUND HEREBY AND UNDERSTANDING THIS DOCUMENT TO BE A COMPLETE WAIVER AND DISCLAIMER IN FAVOR OF Desert CrossFit OF ANY AND ALL LIABILITY, I HEREBY AFFIX MY SIGNATURE HERETO.

Additional policies: There are No make-ups for missed classes. Emergencies, freezes and special consideration will be handled at the trainer’s discretion. Before and after pictures may be requested. Photographers may be present during class time photographing for our ‘Photo Gallery’ and for advertising and media purposes. Please let the trainer know if you have any concerns.

RISK ASSESSMENT

Have you ever had any form of heart disease?:   

Yes No

Have you ever experienced shortness of breath or chest pains?:   

Yes No

Date of last full physcial: (MM/DD/YYYY)


Do you have or do any of the following pertain?
Please explain to the best of your ability?

High Blood Pressure:	Yes No
High Cholesterol:	Yes No
Cigarette Smoking:	Yes No
Smoked in Past:	Yes No   } How long?:
Diabetes:	Yes No    Insulin dependant?:
Family History of Heart Disease:	Yes No
Who?:
Abnormal Resting EKG:	Yes No
Are you active?:	Yes No
Activity or Exercise:
Times per week:
Minutes per session:

Do you have any problems in the following areas?

Knee:	Yes No	Explain:
Low Back:	Yes No	Explain:
Neck/Shoulder:	Yes No	Explain:
Hip/Pelvis:	Yes No	Explain:
Flexibility:	Yes No	Explain:
Any other:	Yes No	Explain:

Are you currently taking any medication?: Yes No

Explain: