Participant Medical Disclosure & Injury Release

Full Name Date of Birth Address Email Phone Emergency Contact Name Emergency Contact Phone

I certify that I am physically fit and have consulted with a physician regarding my ability to participate in fitness activities.

Do you have any medical conditions, injuries, or allergies? No Yes

I understand participation in fitness activities involves risks including injury, illness, or death, and I voluntarily assume all risks.

I release Bodyshift Fitness & Nutrition, LLC from all liability for injuries or damages sustained while participating in activities.

I authorize emergency medical treatment if necessary and accept responsibility for any costs.

I have read and agree to this release and understand it is legally binding

Signature Date: Not signed