Registration — LiveWire Fitness

Become a LiveWire

Thank you for your interest in LiveWire Fitness. Before staring any LiveWire classes please complete the form below.

Tell Us About You

Name

First Name

Last Name

Phone

(###)

###

####

Date of Birth

YYYY

Emergency Contact

First Name

Last Name

Emergency Contact Relationship

Emergency Contact Phone

(###)

###

####

Current Fitness Level and Existing Health Conditions

Rate your current fitness level

Describe your current exercise routine

Has a doctor ever said you have a heart condition that would limit your physical activity?

Are you currently taking medication for blood pressure or a heart condition?

Do you feel pain in your chest when you do physical activity?

Do you lose your balance because of dizziness or do you lose consciousness?

Do you have a bone or joint problem that could be made worse by a change in your physical activity?

Please provide any additional information that you think is important for us to know prior to joining a LiveWire class (e.g. knee or back problem).

LiveWire Class and Trainer

Waiver of Liability and Informed Consent

1) I am participating in the fitness programs (the "Classes") offered by LiveWire Fitness LLC and their agents (collectively "LiveWire") and recognize this requires physical exertion, which may be strenuous and may cause physical injury. I am fully aware of the risks involved. 2) I represent and warrant that I have no medical condition which would prevent my participation in Classes. I understand it is my responsibility to consult with a physician prior to and regarding my participation in Classes. 3) I agree to assume full responsibility for any risks, injuries, or damages, known or unknown, which might occur as a result of participating in Classes. 4) I hereby execute and deliver this waiver releasing LiveWire from and against all claims, costs, liabilities, expenses, and judgment, including attorney's fees and court costs arising of my participation in Classes, or any illness or injury while participating in Classes. I hereby release any claim I may have against LiveWire, for any injury or death caused by their negligence or other acts. 5) I, my heirs, or legal representatives forever release, waive, discharge, and covenant not to sue LiveWire for any injury or death caused by their negligence or other acts. 6) I give LiveWire full consent to capture pictures/images of my likeness during my participation in Classes without requiring remuneration for the same. I agree to release all images of this nature to LiveWire and agree to their use in promotions, social media platforms and the LiveWire website.

Acknowledgment

I hereby affirm that: 1) I voluntarily agree to the terms and conditions above; and 2) I am over 18 or I have obtained express permission from a legal guardian.