Name*
First Last
Date Of Birth*
MM slash DD slash YYYY
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Emergency Contact*
First Last
Emergency Contact Phone*
Date of last full physical:*
MM slash DD slash YYYY
Have you ever had any form of heart disease?*
- Yes
- No
If yes please explain.
Have you ever experienced shortness of breath or chest pains?*
- Yes
- No
If yes please explain.
High Blood Pressure?*
Cigarette Smoking?*
- Yes
- No
Diabetes?*
Family History of Heart Disease?*
- Yes
- No
If yes please explain.
Do you work out at least three times per week?*
- Yes
- No
Are you currently taking any medication?*
- Yes
- No
If yes please explain.
Do you have knee problems?*
- Yes
- No
If yes please explain.
Do you have lower back problems?*
- Yes
- No
If yes please explain.
Do you have neck/shoulder problems?*
- Yes
- No
If yes please explain.
Do you have hip/pelvis problems?*
- Yes
- No
If yes please explain.
Are there any other health concerns or injuries the trainer should know about?*
- Yes
- No
If yes please explain.
Is there any reason you know of that would prevent you from participating in an exercise program?*
- Yes
- No
If yes please explain.
Consent*
I agree to the Consent Agreement.
I agree to participate in one or more physical fitness program(s)/class(es) sponsored by Rising Tide Fitness LLC, which may include, training of any kind by any affiliate, subsidiary or partnership of Rising Tide Fitness LLC (hereinafter collectively referred to as RTF). RTF made me fully aware that the fitness programs/classes which RTF offers and in which I desire to participate are of a nature and kind that are extremely strenuous and can/may push me to the limits of my physical abilities. I the undersigned recognize and understand that the programs/classes are not without varying degrees of risk which may include, but are not limited to the following:Injury to the musculoskeletal and/or cardio respiratory systems which can result in serious injury or death, injury or death due to negligence on the part of myself, my training partner, or other people around me, injury or death due to improper use or failure of equipment, or injury or death due to a medical condition, whether known or unknown by me. I am aware that any of these above mentioned risks may result in serious injury or death to myself and or my partner(s).
Consent*
I agree to the Assumption of Risk agreement.
I willingly assume full responsibility for any and all risks that I am exposing myself to as a result of my participation in RTF programs/classes and accept full responsibility for any injury or death that may result from participation in any activity, class or physical fitness program. I herby certify that I know of no medical problems that would increase my risk of illness and injury as a result of participation in a fitness program designed by RTF trainers. RTF informed me that there exists the possibility of adverse physical changes during an exercise program, and I fully understand the same. RTF informed me that these changes could include abnormal blood pressure, fainting, disorder of heart rhythm, stroke, and in very rare instances, heart attack or even death, and I fully understand the same. With my full understanding of the above information, I agree to assume any and all risk associated with my participation in RTF fitness programs/classes.
Consent*
I agree to the Release agreement.
In full consideration of the above mentioned risks and hazards and in full consideration of the fact that I am willingly and voluntarily participating in the activities made available by RTF, and with my full understanding of all of the above, I hereby waive, release, remise and discharge RTF and its agents, officers, principals and employees and volunteers, of any and all liability, claims, demands, actions or rights of action, or damages of any kind related to, arising from, or in any way connected with, my participation in RTF fitness programs/classes, including those allegedly attributed to the negligent acts or omissions of the above mentioned parties.This agreement shall be binding upon me, my successors, representatives, heirs, executors, assigns, or transferees. If any portion of this agreement is held invalid, I agree that the remainder of the agreement shall remain in full legal force and effect.If I am signing on behalf of a minor child, I also give full permission for any person connected with RTF to administer first aid deemed necessary, and in case of serious illness or injury, I give permission to call for medical and or surgical care for the child and totransport the child to a medical facility deemed necessary for the well being of the child.
Consent*
I agree to the Indemnification agreement.
I recognize that there is risk involved in the types of activities offered by RTF. Therefore I accept financial responsibility for any injury that I or the participant may cause either to him/herself or to any other participant due to his/her negligence. Should the above mentioned parties, or anyone acting on their behalf, be required to incur attorney’s fees and costs to enforce this agreement, I agree to reimburse them for such fees and costs. I further agree to indemnify and hold harmless RTF, their principals, agents, employees, and volunteers from liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in activities offered by RTF.
Consent*
I agree to the use of Pictures/Film/Likeness agreement.
I agree to allow RTF, its agents, officers, principals, employees and volunteers to use picture(s), film and/or likeness of me for advertising purposes. In the event I choose not to allow the use of the same for said purpose, I agree that I must inform RTF of this in writing.
Consent*
I agree to the Covid-19 Assumption of Risk agreement.
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people.

Rising Tide Fitness(RTF) has put in place preventative measures to reduce the spread of COVID-19; however, RTF cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending Rising Tide Fitness could increase your risk and your child(ren)’s risk of contracting COVID-19.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by attending RTF and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at Rising Tide Fitness may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Rising Tide Fitness employees, program participants and their families.

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my attendance at Rising Tide Fitness. On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless Rising Tide Fitness its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the gym, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Rising Tide Fitness program.

At Rising Tide Fitness, we are taking the following precautions to try and keep surfaces and spaces clean, disinfected, and sanitized:

• All coaches and members are to wash hands or use hand sanitizer upon arrival.
• Once equipment has been gathered, the equipment stays with the member until the end of class when cleaning happens.
• After workout/exercise is complete, gym members wash their hands or use hand sanitizer again.
• With clean hands, members are given a rag that has been dipped into a sanitizing solution in which they use to wipe down all of their equipment.
• Coaches are to spray the mats with a disinfectant solution.
• All other high traffic areas are being cleaned and disinfected on a regular cleaning schedule.
Consent*
I agree.
I have fully read and fully understand the foregoing assumption of risk, and release of liability and I understand that by signing it obligates me to indemnify the parties named for any liability for injury or death of any person and damage to property caused by my negligent or intentional act or omission. I understand that by signing this form I am waiving valuable legal rights.
Participant's Name*
First Last
Legal Guardian
First Last