THIS IS AN IMPORTANT DOCUMENT. PLEASE READ CAREFULLY AND FULLY INFORM F45 TRAINING CALOUNDRA AS REQUESTED.
I agree to update F45 Training Caloundra in a timely manner as changes to my medical information occur.
I have advised F45 Training Caloundra if I have (or had) any of the following conditions.
· Rheumatic fever
· Recent operation (provide detail below)
· Edema (swelling of ankles
· High blood pressure
· Low blood pressure
· Lung disease
· Heart attack
· Fainting or dizziness with or without physical exertion
· Diabetes and type
· High cholesterol
· Orthopnea (the need to sit up to breathe comfortably) or paroxysmal (sudden, unexpected attack) nocturnal dyspnea (shortness of breath at night.)
· Asthma or shortness of breath at rest or with mild exertion
· Chest pains
· Palpitations or tachycardia (unusually strong or rapid heartbeat)
· Intermittent claudication (calf cramping)
· Pain, discomfort in the chest, neck, jaw, arms, or other areas with or without physical exertion
· Known heart murmur
· Unusual fatigue or shortness of breath with usual activities
· Temporary loss of visual acuity or speech, or short-term numbness or weakness in one side, arm or leg of your body
· Any other condition?
I have advised F45 Training Caloundra of any medications I am taking.
I have advised F45 Training Caloundra if I have been hospitalized in the past 12 months.
I have advised F45 Training Caloundra if I have pain or have had major injuries in the following area.
· Any other areas with pain or major injuries?
I have advised F45 Training Caloundra if any of my family members have suffered from the following conditions, including at what age the condition occurred.
· Heart disease
· Any other major illness
Acknowledgement of Risks, Injury and Obligations
I acknowledge that the activities I am to undertake have potential dangers and by participating in them I am exposed to certain risks. I acknowledge and understand that whilst participating in any such activities:
· I may be injured, physically, mentally, or may die.
· Any physical conditions I may have, of which I may or may not be aware, of which I may or may not have disclosed to F45 Training Caloundra or its staff and agents, may be aggravated or worsened by my participation.
· My personal property may be lost or damaged.
· Other persons participating in such activities may cause me injury or may damage my property.
· I may cause injury to other persons or damage their property.
· The conditions in which activities are conducted may vary without warning.
· I may be injured or die or suffer damage to my property as a result of the negligence or breach of contract of F45 Training Caloundra, its servants or agents.
· There may be no or inadequate facilities for treatment or transport of me if I am injured.
I assume the risk of, and the responsibility for any injury, illness, death or property damage resulting from my participation in any activities.
Release and Indemnity to F45 Training Caloundra In consideration of the acceptance of my payment (or guest status) for participating in any activity (and except to the extent that the centre may be precluded by statute) I agree to release and indemnify F45 Training Caloundra and staff as follows:
· I participate in the activities at my sole risk and responsibility.
· I release, indemnify and hold harmless F45 Training Caloundra, its servants and agents, from and against all and any actions or claims which may be made by me or on my behalf or by other parties for or in respect of arising out of any injury, loss, damage or death caused to me or my property whether by negligence, breach of contract or in any way whatsoever.
I also agree that in the event that I am injured or my property is lost or damaged, I will bring no claim, legal or otherwise, against F45 Training Caloundra or its servants and agents, in respect of that injury, loss or damage.
Before signing this document I have read and understand it and know how it affects my legal rights.
I also agree to allow F45 Training Caloundra from time to time the ability to take a video or photo to use for promotional purposes.