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Risk Factor Questionnaire
Health & Fitness History
By signing this document I acknowledge that I have voluntarily chosen to participate in a program of aggressive physical exercise, which can enhance the musculoskeletal and cardiovascular systems. In signing this document, I acknowledge being informed of the strenuous nature of the program and the potential for unusual, but possible physiological results including but not limited to abnormal blood pressure, fainting, heart attack or death. I attest that I am physically fit without and medical or health problem. I have arranged for medical insurance coverage and such life insurance, as I deem necessary or advisable.
I hereby release and absolve Jesse Macrae, Andrew Menton, Newport Boxfit, Pulse Newport and all employees, agents, officers, directors, and other persons from any and all liability for injury, disability, death, or other loss incurred by me while using the facilities and equipment and engaging in personal fitness training and other activities except that this release shall not apply to willful malfeasance or intentional wrongdoing.
I covenant not to commence any lawsuit or take any other proceeding or action against Jesse Macrae, Andrew Menton, Newport Boxfit, Pulse Newport, or any employees, agents, officers, directors, and other persons for any such liability, each and all of whom agree to indemnify and hold harmless from all costs and expenses. including reasonable attorney's fees, they may incur in the event any such lawsuit, proceeding or action is taken
I authorize Newport Boxfit LLC to use photos, and or videos of myself and or my child or the child for whom I have legal guardianship for any promotional materials regarding Newport Boxfit programs, facilities, or services. Material will not be sold to other parties. Promotional materials bearing these likenesses may be distributed for free to the public and posted on the Newport Boxfit website and social media. Newport Boxfit reserves the right to use any photo or likeness for a time period beginning when this form is signed and ending upon written request of participant, parent or legal guardian
I understand that questions about exercise procedures and recommendations are encouraged and welcomed