New Member Registration & Waiver Form

Thank you for registering with P31 Fitness, LLC.

Once you submit this registration form, you will be sent a confirmation email.

General Information
First Name	*
Last Name	*
Address	*
City	*
State	*
Zip	*
Date of Birth	*
Phone Number	*
Work Number	*
Email Address	*
Emergency Contact Name	*
Emergency Phone Number	*

Goals This Month
1.
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Pick a Session for Sulphur Springs
Class:
Payment Method:

Medical History
1. Do you have diabetes?
List Medications:
2. Have you ever been found to be anemic? (low blood count)
3. Do you have High Blood Pressure?
List Medications:
4. Do you have or ever had the following?
Heart Disease
Lung Disease:
Kidney Disease:
Liver Disease:
5. Do you have asthma?
List Medications:
6. Have you ever had a severe Neck or Back injury?
Please Describe:
7. Have you had a broken bone or fracture in the past 2 years?
Please Describe:
8. Do you have back pain?
9. Have you had knee pain in the past 2 years that has disabled you for longer than a week?
Please Describe:
10. Do you have other conditions which cause pain?
Describe:

Release
NOTICE: It is wise to seek your doctors advice before beginning any health, fitness, nutritional program! This release is entered into between the undersigned and P31 Fitness, LLC. its officers, subsidiaries, affiliates, and executors in addition to the City of Sulphur Springs, TX. The purpose of P31 Fitness, LLC. is to provide women of all levels of fitness an opportunity to workout together and gain from the experience Mentally, Emotionally, Physically, and Spiritually. The undersigned hereby acknowledge that the following was explained to me and/or agree to the following: 1. Acknowledges that Rachel Curtis is not a physician and is not trained in any way to provide medical diagnosis, medical treatment, or any other type of medical advice. 2. Acknowledges that coaching/training is another tool for teaching athletes/individuals about themselves, but that P31 Fitness, LLC. does not guarantee neither good nor bad will occur nor guarantees the training advice given by Rachel Curtis including P31 Fitness, LLC. will produce good nor bad results. 3. Acknowledges that the undersigned has been told if they feel tired, feel pain or feel out of the ordinary in any way either related to your training, or otherwise, that the undersigned should contact a physician at once. 4. Acknowledges that boot camps, aerobic classes, kick boxing, running, combo classes, weight training, obstacle courses, and any other related exercises are a test of one's mental and physical limits and carry with it potential for damage or loss of property, serious injury and death. That the undersigned assumes the risks of participating in these types of events/activities including the elements of a natural environment, that they are fit, and they have a regular medical physician they can contact regarding any medical problems that they might develop. The undersigned expressly waive, release, discharge and agree not to sue from any liability of death, disability, personal injury, or action of any kind P31 Fitness, LLC. for the undersigned participating in said sporting events and/or training for said sporting events. The Undersigned agrees that this is the full agreement between the parties, that P31 Fitness, LLC. including Rachel Curtis nor anyone else has not verbally contradicted any of the terms of this release and that the undersigned has entered into this agreement free and voluntarily without force or coercion. Customer client agrees to confidentiality with respect to P31 Fitness, LLC. and all services provided by same. The undersigned agrees to refrain from disclosing, directly or indirectly, any and all aspects of P31 Fitness, LLC. The undersigned agrees to a non-compete within a 50 mile radius of Sulphur Springs, TX for a period of 5 years from date of participation.

Read & Check the Following
I agree not to use the words: CAN'T, TOO HARD, IMPOSSIBLE, or I QUIT I agree to commit myself to the workouts and to reach my goals. I agree to show up for my assigned workout class prepared and on time. I understand that photos or video may be taken during the course of my involvement in P31 Fitness, LLC. fitness classes, which may be used for promotional purposes. I understand there is a no refund policy. I understand prior to the start of any P31 Service,class,session,etc. I will have to go on-line to register for that service and pay the appropriate fee. I understand that diet and nutrition will greatly effect my fitness goals and performance. I will bring a positive attitude, strong work ethic, and expect to have FUN!
I agree to all Terms and Conditions listed above and I am the applicant.