All information on this form will be treated as strictly confidential.
Please read through the questions carefully before accepting. If you answered yes to any of the following questions please advise your coaches at the start of the class.

1) Has your doctor ever said that you have a heart condition and recommended only medically supervised physical activity?

2) Have you had chest pain when you were or were not doing physical activity?

3) Do you lose your balance due to dizziness or do you ever lose consciousness?

4) Do you have a bone, joint or other problem that causes you pain or any limitations to address when developing a program (e.g. arthritis, high blood pressure, high cholesterol, osteoporosis, anorexia, anaemia, epilepsy, respiratory ailments, back problems etc.)?

5) Have you had recent a surgery?

6) Do you take any medications that might affect your physical performance or well-being?

7) Do you know of any other reason why you should not engage in physical
activity?

8) Are you or have you been pregnant in the last 6 months?

TERMS & CONDITIONS:
I wish to participate in the exercise and training program offered by CrossFit Atara. I understand there are inherent risks in participating in a program of strenuous exercise. Consequently, I have been examined by a physician of my choice and have obtained his/her approval for my participation in a fitness program within sixty (60) days of the date set forth below. No change has occurred in my physical condition since the date such approval was given which might affect my ability to participate in the fitness program. If a physician has not examined me, I agree to see a physician within sixty (60) days of the date set forth below to obtain his/her approval for my participation in a fitness program. I agree that CrossFit Atara shall not be liable or responsible for any injuries to me resulting from my participation in the fitness program (whether at home, at the training studio, outdoors, or at a corporate, commercial, residential or other fitness facility) and I expressly release and discharge CrossFit Atara and its owners, employees, agents and/or assigns, from all claims, actions, judgments and the like which I or my heirs, executors, administrators or assigns may have or claim to have as a result of any injury or other damage which may occur in connection with my participation in the fitness program, excepting only an injury caused by the gross negligence or intentional act of such person or persons. This Release shall be binding upon my heirs, executors, administrators and assigns.
I understand that I am not obligated to perform nor participate in any activity that I do not wish to do, and that it is my right to refuse such participating at any time during my training sessions. I understand that should I feel lightheaded, faint, dizzy, nauseated, or experience pain or discomfort, I am to stop the activity and inform my Trainer.
I understand the results of any fitness program cannot be guaranteed and my progress depends on my effort and cooperation in and outside of the sessions.
I understand that during a training session, my trainer may have to use Touch Training to correct alignment and/or to focus my concentration on a particular muscle area to be targeted. If I feel uncomfortable or experience any type of discomfort with Touch Training, I will immediately request that my trainer discontinue using this technique.
I understand the usage of any nutritional supplements is done under my own will.
I understand that CrossFit Atara may photograph and/or film their client events/sessions and I agree to allow them to use these pictures, films, and/or likenesses of me for promotional purposes. In the event I choose not to allow the use of the same for said purpose, I agree that I must inform CrossFit Atara of this in writing.