Minor Waiver Form – Fitness Lounge

Please Select Facility

Steinway Location (30-77 Steinway Str, LIC, NY)
31st Str. Location (2579 31st Str, LIC, NY)
UES 88th (1695 1st Ave., NY, NY)
Gramercy (291 3rd Ave., NY, NY)

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;

I Have Read and Agree to the Minor Training & Therapy Services Waiver and Release
I Have Read and Agree to the Privacy Policy

Signature

Clear Signature

I am the parent or legal guardian of the minor named above. By signing below, I confirm that I have read, understand, and voluntarily agree to the Minor Fitness & Wellness Services Waiver and Medical Consent linked above. I give permission for the minor to participate in training, exercise, therapy, or related services and accept all terms, risks, and conditions on their behalf. I understand that my digital signature has the same legal effect as a handwritten signature.