Prior to commencing exercise program, please complete the Health questionnaire below in detail.
(Please complete each section below)
Address Street 1
City And State
Zip Code (5 Digits)
Phone Or Cell Phone
Please list any pre-existing conditions:
Please list any medications you are currently using:
List any weight training equipment
Emergency Contact Phone
*Release Disclaimer: Pre-paid programs do not offer refunds or makeup classes. Any technical or other reason for a missed class and any cancellation or postponement of the scheduled sessions will be charged. I understand that fitness activities involve a risk of injury and assume the full risk of and release Marc D. Thompson from any liability. I do hereby further declare myself to be physically sound to participate in exercises or use of equipment or machinery. ½ hour sessions average about 27 minutes; 1 hour sessions average about 55 minutes. Hour sessions and housecalls are double the rate listed. Additional $10 fee per session for check/money order/card.
I have read and understood the release disclaimer
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