Release Form 2023 Virtual | Custom Health Fitness

Release Form

Release Agreement

Buyer Information only——-To be filled out by applicant——-Please print clearly

"*" indicates required fields

Last Name*

First*

Birth Date

Age

Address

Current Billing Address City State Zip

Home Phone

Mobile Phone

E-mail Address*

Method of Payment

Automatic Bank Draft (ACH from checking account)

Check- Issued Payment

(Must provide an automatic checking account # or credit card if using a check)

Total:

Waiver and Release of Liability
Custom Health & Fitness Inc. urges all clients to obtain a physical examination from a doctor before participating in any exercise program. All exercises, including the use of free weights and use of any machinery, equipment and apparatus designed for exercise, shall be at the member’s sole risk. Members understand the agreement to use, or the selection of any exercise program, and the types of equipment chosen shall be members’ entire responsibility and that Custom Health & Fitness Inc. shall not be held liable for any claims, demands, injuries, or damage due to members’ actions. Members understand that virtual training is “use at your own risk at all times, under every circumstance.” Members agree and understand that they must be 18 years of age. Members hereby hold this business, its officers, owners, and agents harmless from all claims which may be brought against them by a member’s behalf for any such injuries or claims. THERE IS A NO-REFUND POLICY ON SCHEDULED PERSONAL TRAINING. WE RESERVE THE RIGHT TO REFUSE SERVICE TO ANYONE AT ANY TIME FOR ANY REASON WITHOUT REFUND.

Member Signature

Date

Phone

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