Next Level Waiver/ Goals (20-21)

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UPDATED 6/16/2021

Thank you for trusting Next Level to help you reach your personal goals!

Due to recent changes in NY State COVID-19 guidelines, we will need all members, athletes and staff to complete the form below before your next session.

Please review our mandated COVID-19 safety procedures below:
- Please STAY HOME if you do not feel well!
- All non vaccinated members, athletes and staff must wear a mask upon entry and at all times while inside the Next Level facility!
- Hand sanitizer and disinfectant spray will be provided throughout the facility.
- All equipment and surfaces must be disinfected after use and/or between sets if sharing with another person.
- Floors will be mopped and all surfaces will be disinfected between each session.
- An industrial air purifier meeting Ashrae standards will run 24 hours/ day.
- The facility will be disinfected with an industrial fog cleaner each week.
* Masks are optional if vaccinated or training outdoors.

Please contact us with questions, or if you would like to view our official safety plan submitted to NYS.

Thank you again for your understanding and support!

Email *

Last Name *

First Name *

Date of Birth *

YYYY

Select One *

Do you understand and agree to follow all COVID-19 safety guidelines listed above? *

Yes

Cell *

Home Address *

Age *

Parent Email if under 18

Emergency Contact Name/ Cell *

Instagram Handle

Sport(s)

Level

Middle School/ Travel

HS/ Travel

College

Pro

Personal Goals (WHY are you training with us?) *

List all Injuries, Health Conditions and/or Restrictions that may affect training *

Do you currently have any fitness, sport or health restrictions from a medical professional? *

Yes

Does the participant have chest pain, dizziness, fainting, during or after exertion? *

Yes

Shirt Size *

YXL

XXL

I, being 18 years of age or older, do for myself (and for or on behalf of my child participant, if said child is not of age or older) do hereby release, forever discharge and agree to hold harmless Next Level Strength & Conditioning, LLC, Nathan J. VanKouwenberg, or any other owners, subcontracted trainers, or employees of Next Level Strength & Conditioning, LLC, while participating in supervised, or independent fitness training at the Next Level Strength and Conditioning training facility at in Fairport, NY, or at any other location, from any and all liability, claims or demands for personal injury, sickness or death, as well as property damages and expenses, of any nature whatsoever which may be incurred by the undersigned and/or the child participant that occur while said participant is participating in the above described activities. I (and/or the child participant) am aware that Nathan J. VanKouwenberg and other Next Level employees are not licensed physical therapists or trained medical personnel and am participating in this program voluntarily at my own risk and for recreational purposes only. I acknowledge that fitness training may be strenuous and that a physician’s examination and approval should be obtained prior to beginning any fitness program. I understand that it is my responsibility to notify Next Level staff of all restrictions and dates of release provided by Doctors and/or Physical Therapists. NLSC Staff will follow all state, county and district mandated COVID-19 safety guidelines. I acknowledge that NLSC Owner and Staff will not be held liable for any assumed contraction of the COVID-19 virus while participating in NLSC programs or under the supervision of NLSC Staff. I accept all responsibility for my (and/or the child participant’s) health and any resultant injury or illness that may occur during any Next Level Strength and Conditioning training session and agree to hold harmless and indemnify Next Level Strength & Conditioning, LLC, including owners, and any other Next Level employee or sub-contracted trainer. I understand that Next Level Strength & Conditioning, LLC are not responsible for safety of equipment and/or training environment when training is conducted off site. I (and/or the child participant) also give Next Level Strength and Conditioning permission to take and post pictures and videos of me (and/or the child participant) participating in fitness activities for marketing purposes only. *

I being at least 18 years of age (or Parent/ Guardian) understand and agree to waive all liability

A copy of your responses will be emailed to the address you provided.

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