PT Waiver Under 18 – Fitness Lounge

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Full Name of Minor

First

Last

Full Name of Parent/Guardian

First

Last

Email of Parent/Guardian

Phone of Parent/Guardian

Trainer/Instructor/Therapist Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

List any Medical/Health Conditions of Minor

Please Read and Agree to the Following;

The Minor named above, has been cleared by a Health Care Provider to participate in Physical Activity.
I Have Read And Agree To The Assumption of Risk and Waiver of Liability
I Have Read And Agree To The Acknowledgment of Independent Personal Trainer
I Have Read And Agree To The Waiver of Liability and Indemnification
I Have Read And Agree To The Consent for Medical Treatment

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