Kinetics Registration Form

Please complete this form prior to taking any class at/with Kinetics.

Email(Required)

Full Name(Required)

Phone Number(Required)

Street Address(Required)

City(Required)

State(Required)

Zip Code(Required)

Date of Birth(Required)

How did you hear about us?(Required)

I was referred by (if referred):

Please list any injuries or health conditions you are aware of:

What are you most frustrated with when it comes to getting in shape?

What made you decide to come to us today and not last week, last month, etc?

What are the main benefits that you'd like to achieve at Kinetics? (Please be specific)

I have read and understood the Liability Waiver above and clicking the checkbox equals an electronic signature(Required)

I Agree

Liability Waiver

PARTICIPANT ACKNOWLEDGES AND ASSUMES ALL RISKS AND FULLY RELEASES KINETICS FROM ALL LIABILITY FOR FITNESS TRAINING ONSITE AT KINETICS, OUTDOORS and/or ONLINE VIRTUALLY. THIS INCLUDES, BUT IS NOT LIMITED TO: KINETICS EMPLOYEES, CONTRACTORS, OFFICERS, AND/OR OWNER. PARTICIPANT ACKNOWLEDGES THAT PHYSICAL ACTIVITY INVOLVES THE INHERENT RISK OF PHYSICAL INJURIES OR OTHER DAMAGES, INCLUDING BUT NOT LIMITED TO HEART ATTACKS, MUSCLE STRAINS, PULLS, TEARS, BROKEN BONES, SHIN SPLINTS, HEAT PROSTRATION, KNEE/LOWER BACK/ FOOT INJURIES AND ANY OTHER ILLNESSES, SORENESS, OR INJURY HOWEVER CAUSED, OCCURRING, DURING OR AFTER PARTICIPATION IN THE PHYSICAL ACTIVITY ENGAGED IN. PARTICIPANT FURTHER ACKNOWLEDGES THAT SUCH RISKS ARE NOT CAUSED BY THE NEGLIGENCE OF AN INSTRUCTOR OR OTHER PERSON, DEFECTIVE OR IMPROPERLY USED EQUIPMENT, OVER-EXERTION OF A PARTICIPANT, SLIP AND FALL OF A PARTICIPANT, OR UNKNOWN HEALTH PROBLEM OF A PARTICIPANT. PARTICIPANT AGREES TO ASSUME ALL RISK AND RESPONSIBILITY INVOLVED WITH PARTICIPATION IN THESE PHYSICAL ACTIVITIES (ONSITE AT KINETICS, OUTDOORS ONLINE VIRTUALLY), PARTICIPANT AFFIRMS THAT THEY ARE IN GOOD PHYSICAL CONDITION AND DO NOT SUFFER FROM ANY DISABILITY THAT WOULD PREVENT OR LIMIT PARTICIPATION IN THESE PHYSICAL ACTIVITIES. PARTICIPANT ACKNOWLEDGES PARTICIPATION WILL BE PHYSICALLY AND MENTALLY CHALLENGING AND PARTICIPANT AGREES THAT IT IS THE RESPONSIBILITY OF THE PARTICIPANT TO SEEK COMPETENT MEDICAL OR OTHER PROFESSIONAL ADVICE REGARDING ANY CONCERNS OR QUESTIONS INVOLVED WITH THE ABILITY OF PARTICIPANT TO PARTAKE IN ACTIVITIES. BY SIGNING THIS DOCUMENT, PARTICIPANT AGREES TO ASSUME ALL RISK AND RESPONSIBILITY FOR NOT EXCEEDING HIS OR HER PHYSICAL LIMITS. PARTICIPANT UNDERSTANDS PHOTOS OR VIDEOS MAY BE TAKEN DURING THE COURSE OF HIS/HER INVOLVEMENT IN CLASSES OFFERED AT KINETICS FACILITIES, WHICH MAY BE USED FOR PROMOTIONAL PURPOSES.

A copy of your responses will be emailed to the address you provided.