Please Download, read and fill out the Signup form/waiver and email it or bring it in before you come in for class. Thank you.

HEALTH QUESTIONNAIRE FOR: __________________________________
Read the following questions carefully and circle yes or no:
1. Do you have any current illnesses, like a cold or respiratory inflammation?  Yes/No
2. Has your doctor ever told you that you have heart trouble? Yes No
3. Do you sometimes have pains in your heart or chest? Yes No
4. Do you often feel faint of have dizzy spells? Yes No
5. Has your doctor ever told you that your blood pressure is too high? Yes No
6. Has your doctor ever told you that you have a joint or bone problem, like
arthritis? Yes No
7. Do you have back or neck problems? Yes No
8. Do you have problems with your wrist, knees, elbows, or shoulders? Yes No
9. Are you pregnant? Yes No
10. Have you had surgery in the past year? Yes No
11. Are you over age 65 and not accustomed to physical exercise? Yes No
12. Is there a good physical or psychological reason not mentioned here why you should not begin, or why you should be especially careful, during an exercise program? Yes No

NOTE: If you answered yes to any of the above questions, CONSULT WITH YOUR DOCTOR BY PHONE OR IN PERSON, BEFORE INCREASING YOUR ACTIVITY LEVEL. Find out, with medical evaluation from your doctor, whether you are okay for: unrestricted physical activity, gradually-increasing activity, or restricted activity for a period of time. I have answered these questions accurately.

Signed: ____________________________ Date: __________________________

WAIVER/RELEASE FORM

By signing below, you agree that training and exercise, and especially Boxing Training/Class/Sessions/Participation/ etc., are strenuous in nature and therefore dangerous. You, the Client/Member_________________________, are aware that you are engaging in physical exercise and that the use of equipment, training, and instruction could cause injury, death, broken bones, hart attack, brain injury, viruses, comas, sprains, trauma, mental diseases, paralysis, and other life threatening and non-life threatening diseases and injuries not mentioned here. You are voluntarily participating in these activities with all of this in mind and assume all risks of injury that may result. You agree to waive any and all claims or rights you may otherwise have to sue or otherwise bring action against Rough ‘N’ Tough Boxing or any agent, employees, associates, affiliations, business partners,  or instructors,  affiliates or anyone else directly or indirectly associated with D. Christian_ /Rough ‘N’ Tough Boxing Club for injury to you as a result of these activities. You further agree that you have consulted your physician prior to beginning this exercise program and have been Cleared by your physician to participate.

Signed: ___________________________ Date: ____________________________
   
Contact Sheet
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Address:
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Phone (H):
Phone (W)
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Start Date:
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