Wellness Elevate Liability & Par-Q
I know this isn't the most exciting thing to do, but this needs to be completed before participation in an exercise class with me. 💪By completing this form, you're agreeing to the following terms:

✔️I understand that I have the complete right to stop or decrease exercise at any time during a session, and that it is my obligation to notify my physician or seek medical attention immediately if I develop any symptoms such as fatigue, shortness of breath or chest discomfort.

✔️I realize that participation includes but not limited to exercising, use of exercise equipment and strenuous exertion (strength training) all of which increase heart rate and body temperature.

✔️I understand that exercise involves certain risks, including but not limited to, serious neck and spinal injuries resulting in complete or partial paralysis, heart attack, stroke or even death. Also, injuries could occur to bones, joints or muscles. Slips, falls, and unintended loss of balance could result in muscular, neurological, orthopedic or other bodily injury. I understand that part of the risk involved in undertaking any activity or program is relative to my own state of fitness or health (physical, mental, or emotional) and to the awareness, care and skill which I conduct myself in that activity or program.

✔️Knowing the material risks and appreciating, knowing and reasonably anticipating that other injuries are a possibility, I hereby expressly assume all of the delineated risks of injury, all other possible risk of injury, and even risk of possible death, which could occur by reason of my participation.

✔️I do hereby waive, release and forever discharge Wellness Elevate, LLC from any and all responsibilities or liability for any present and future injuries or damages resulting or arising from my participation in any activities including but not limited to use of the nutrition guide, exercise, personal training or use of the equipment including any injuries and damages caused by the negligent act or omission of any of those persons or entities mentioned above.

✔️By completing this form, I declare that I have read, understand and agree to the contents of this Terms and Conditions page in its entirety. I understand that the Assumption of Risk, Waiver of Liability, and Personal Training Policies and Procedures are intended to be as broad and inclusive as permitted by the state of Florida and agree that if any portion is held invalid, the remainder will continue in full force and effect.
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Email *
Name (First and Last) *
What is your age and date of birth?
Have you ever had any pain or injuries (ankle, knee, hip, back, shoulder, etc.)? If yes, please explain.
Have you ever had any surgeries? (If yes, please explain and include the dates of surgery.)
Has a medical doctor ever diagnosed you with a chronic disease, such as coronary heart disease, coronary artery disease, hypertension (high blood pressure), high cholesterol or diabetes or is there ANY reason that you might need medical clearance before starting this program? (If yes, please explain.)
Are you taking any supplements or medications? Please list what you take and what it is for. *
What obstacles, challenges, and struggles do you come up with regarding diet/lifestyle? *
Do you know how many steps you take in a day?
What exercise equipment do you have at home?
Is there anything else I should know?
I do hereby waive, release and forever discharge Wellness Elevate, LLC from any and all responsibilities or liability for any present and future injuries or damages resulting or arising from my participation in any activities including but not limited to use of the nutrition guide, exercise, personal training or use of the equipment including any injuries and damages caused by the negligent act or omission of any of those persons or entities mentioned above.
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