Waiver

First Name(*)

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Last Name(*)

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Email Address(*)

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Age(*)

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Cell Phone(*)

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DO YOU CURRENTLY BELONG TO ANOTHER RUGBY CLUB?

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Rugby Club Name

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ANY INJURIES IN THE PAST 12 MONTHS

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Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?(*)

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Have you developed chest pain in the past 12months?(*)

YesNo Please choose one

Do you lose your balance because of dizziness or do you ever lose consciousness?(*)

YesNo Please choose one

Do you have a bone or joint problem that could be aggravated by the proposed physical activity?(*)

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Are you aware, through your own experience or a doctor’s advice, of any other reason why you should not exercise without medical approval?(*)

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my obligation to immediately inform my coach of any pain, discomfort, fatigue or any other symptoms that I may suffer during and immediately after any test and all training sessions;
my understanding that there are potential risks: i.e., episodes of transient lightheadedness, fainting, abnormal or increased blood pressure, chest discomfort, leg cramps and muscular discomfort, and that I assume willfully those risks;
my understanding that I may stop or delay any further testing or training if I so desire and that the sessions may be terminated by the appraiser upon observation of any symptoms of distress or abnormal response;
that I have read, understood, and completed the Physical Activity Readiness Questionnaire (PAR-Q), the Yes and No questions previously answered.
that I hereby release Personal Best, its agents, officers, trainers, coaches and employees from any liability with respects to any damage or injury (including death) that I may suffer during any testing and / or any and all training sessions at my club, my home, all training facilities or locations and any Personal Best studio.

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I Agree to this waiver You must agree to the waiver.

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Rugby Waiver