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THE FITNESS FARM

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Pricing & Plans

Gym & Fitness Liability Waiver

First name

Last name

Date of Birth

Do you have a doctor’s permit to participate in intense physical activities?

Yes

Any History of Heart and Cardiovascular Disease

Heart

High blood Pressure

Cardiovascular

Family History

Pregnant, Medications, Other conditions that may limit your ability to exercise?

Pregnant?

On Medications?

Other Medical Conditions

Headaches & Dizzyness

Migraine

Common Headaches

Dizzyness

Fainting

I declare that the info I’ve provided is accurate & complete

I hereby acknowledge this release from liability for accidental injury or illness which I may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.

Please specify anything we should know about

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Country

Phone

Initials

Thanks for submitting!

GET IN TOUCH

Everything we do, we believe in challenging the status quo, cultivating and growing the inner athlete that exists in us all. Founded in 2018 by Chiropractor and Fitness Professional, Dr. Kelly Maguire, our mission is to help you get to your goals. From open gym memberships to personal training and special events-we’ve got all your needs covered.

143 South Blvd, San Mateo, CA 94402, USA

1-650-288-9310

drkelly@thefarmsanmateo.com

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THE FITNESS FARM

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