Name *
E-Mail *
Phone Number *
Instagram Handle (Please N/A if you do not have instagram) *
How did you hear about VFH? If a VFH member, past or present, let us know who referred you so we can thank them! *
DOB *
Height
Weight
Gender * Male Female Prefer not to respond
Emergency Contact Name *
Emergency Contact Number *
Do you have a heart condition? * Yes No
Have you ever suffered a stroke? * Yes No
Do you ever feel unexplained sharp pains in your chest? * Yes - during physical activity Yes - during day to day life No
Do you ever feel faint or suffer from dizziness? * Yes - during physical activity Yes - during day to day life No
Do you suffer from Asthma? * Yes No
Do you have any muscle, bone or joint problems that could be made worse during physical activity? * Yes No
Do you smoke cigarettes daily? * 0-5 daily 5+ daily No
Do you drink alcohol daily? * 0-2 daily 2+ daily No
Have you been told you have high blood pressure? * Yes No
Have you been told you have high cholesterol? * Yes No
Do you have any other medical conditions that may make it dangerous for you to particpate in physical activity or require a medical clearance for you to partake in sessions at Velocity Fitness and Health PTY LTD? * Yes No
What are you interested in here at The Stomping Ground? * Open Gym Full Access (Classes + Open Gym + Recovery)
I confirm that: I have voluntarily chosen to participate in Coach-led group classes or self-led open gym at Velocity Fitness and Health. I am aware that the activities I will undertake are strenuous in nature and may push me to my physical limits of ability. I accept that these activities are dangerous and can result in serious injury or death. I understand that the actions of myself and those around me, improper use or failure of equipment, or a medical condition, known or unknown, may result in serious injury or death. I willingly accept the risks involved and I am responsible for my own actions and/or involvement. I am under no obligation to participate or complete the activities if I have concerns about my ability to do so. If anything is unclear to me in the briefing I will raise my concerns with the Coach. To the best of my knowledge, I am physically able to participate in the activities and know of no reason as to why I should not. In full consideration of the above mentioned risks and hazards and in full consideration of the fact that I am willingly and voluntarily participating in the classes, and with my full understanding of all of the above, I hereby waive, release, remise and discharge Velocity Fitness and Health and its Coaches and employees of any all liability, claims, demands, actions or right of action, or damages of any kind related to, arising from, or in any way connected with my participation in the activities including those allegedly attributed to negligent acts or omissions of the above-mentioned parties. I have fully read and understood the foregoing assumption of risk and release of liability, and I understand that by signing it obligates me to indemnify Velocity Fitness and Health and all parties named for any liability for injury or death of any person and damage to property caused. I understand that by signing this form I am waiving valuable legal rights. I agree to the Velocity Fitness and Health liability waiver. *
