Blackhawk Fitness

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BOOT CAMP WAIVER

I agree to participate in Blackhawk Fitness with a professional Blackhawk Fitness Instructor. I recognize that exercise is not without varying degrees of risk to musculoskeletal and/or cardiorespiratory systems. I hereby certify that I know of no medical problems that would increase my risk of illness and injury as a result of participation in a fitness program designed by Blackhawk Fitness. I understand and have been informed that there exists the possibility of adverse changes during the exercise program. I have been informed that these changes could include abnormal blood pressure, fainting, disorder of heart rhythm, stroke, and very rare instances of heart attack or even death. I agree to waive, release, remise and discharge Blackhawk Fitness and its agents, officers, principals and employees of any and all claims, demands, actions or damages of any kind resulting from participation in Blackhawk Fitness classes or individual training sessions, Blackhawk Fitness Challenge, or any activities under the instructions of Blackhawk Fitness personnel. The undersigned hereby releases Blackhawk Fitness as well as waives any and all claims and understands and assumes any and all risk with participation in any Blackhawk Fitness or Blackhawk Unlimited programs.

I understand and acknowledge that neither my Instructor nor any of the agents, principals, officers or employees of Blackhawk Fitness or Blackhawk Unlimited are medical professionals and have not utilized the information disclosed herein to determine my fitness to participate in this program.

I hereby understand that by SUBMITTING this document to Blackhawk Fitness, LLC, that I am agreeing to participate in this program of my own free will and further understand that injury, broken bones, pulled or torn ligaments, heat injuries, and many other types injury are possible when committing to ANY exercise program, including Blackhawk Fitness, LLC and their Boot Camp, Combat Fitness, Combatives, First Aid, Tazer training, Pistol Training, or any training program associated with or led by Blackhawk Fitness, LLC instructors. Upon submitting this document I acknowledge and agree that under no circumstances will I hold liable Blackhawk Fitness, LLC or its instructors, staff, associated personnel, partners, landlords, or other Blackhawk Fitness, LLC participants for injuries I may receive while travelling to, from, or while participating in Blackhawk Boot Camp, or other Blackhawk Fitness, LLC, or Blackhawk Unlimited training.

* Required
Last Name*
Please Enter your Last Name
First Name*
Please Enter your First Name
CELL Phone Number*
Please provide a CELL phone number that we can use to notify you (via call or text message) in case of a training schedule change.
What is your Date of Birth

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Sex
Female Male
Height
Please tell us your height in inches
Weight
Please tell us your current weight in pounds.
Have you participated in Blackhawk Boot Camp Fitness before?

Yes No
What is your current level of fitness?
How much do you exercise now?
Sedentary (No Exercise)
Occassionally (Once per month or less)
Active (Once per week)
Very Active (Three or more times per week)
Crossfit! (I workout five days or more per week!)
Please tell us about any medical concerns
Check all that apply.
High Blood Pressure
High Cholesterol
Smoker
I have smoked in the past
Family history of heart disease
Do you have any problems in the following areas
Please check all that apply
Knees
Low Back
Neck/Shouders
Hips/Pelvis
Flexibility issues
Please tell us about any other existing conditions that may keep you from performing certain exercises
Please let us know about any pre-existing conditions that you may have.
Please let us know if you are taking any medications.
Please list any prescription medications you are taking
Emergency Contact Name
Please provide the name of someone you would like contacted in case of an emergency
Emergency Contact Phone
Please provide the phone number of the above individual including AREA CODE
Are you Active, Reserve, National Guard, or a Military Veteran?
Please provide a copy of your ID with your Fitness Waiver.
Yes No
Are you in Law Enforcement or Fire Department?
Please provide a copy of your ID with your Fitness Waiver.
Yes No
Are you a City, County, State, or Federal Employee?*
Please provide a copy of your ID with your Fitness Waiver.
Yes No
 

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