HEALTH FORM DISCLAIMER

Fitness Health Waiver

Please fill out the following medical form

First Name

Email Address

Last Name

Date of Birth

Do you have a history of heart problems, chest pain or a stroke?

Yes

Do you have a history of High Blood Pressure, chronic illness or breathing problems?

Yes

Do you have any injurys or health probelms which will be made worse by exercise?

Yes

If you answer yes to any of the above disclaimer please see your doctor before starting any new exercise programme. You are taking part in exercise at your own risk. Therefore no liability will be accepted by Studio 54 Fitness or its staff while you participate in any fitness or treatments.

Initials

Today's Date

I declare that the info I’ve provided is accurate & complete. I understand i am taking part in exercise at my own risk.

Thanks for submitting!