Do you have any Rheumatic or Osteo-Athritic condition?
Are you Pregnant?
Do you have any Screws/Plates?
Do you have any Bronchitis condition?
Did you have a Hysterectomy?
Do you have a Pacemaker?
Do you have any Tumours/Growths condition?
Do you have High/Low blood pressure?
Do you or have you suffered from Diabetes?
Do you or have you suffered from Epilepsy/Fits?
Emergency Contact
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Relationship
Phone
Email
Liability Waiver
In agreeing to this waiver, I agree not to hold Starks Fitness or its trainers responsible for any injuries or other misfortune sustained while attending services.