Athlete's Arena Registration Form

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The following is an important legal document. It is important that you read it and understand it completely.

By filling out the information below I agree that Athlete's Arena and is in no way responsible for the safekeeping of my personal belongings during my visit. I understand that classes at Athlete's Arena may be physically strenuous and I voluntarily participate in them with the full knowledge that there is a risk of personal injury, property loss or death. I agree that neither I, my heirs, assigns or legal representatives will sue or make any other legal claims of any kind against Athlete's Arena or its members for any personal injury, property damage / loss or wrongful death, whether caused by negligence of otherwise.

Client Name: *

Gender: *

male

female

Date of Birth: *

Address: *

City: *

State: *

Zip Code: *

Email Address: *

Phone number: *

Parent / Guardian Name:

Address:

City:

State:

Zip Code:

Email Address:

Phone number:

How did you hear about us?

drive-by facility

event

referred

search engine

Other:

Clear selection

Trainer you will be working with: *

Shane Miller

Adriane Wilson

Heather Kobus

Jason Brunson

Jeffrey Steedley

Other:

Interest:

Personal Training

Kettlebell Training

CrossFit

Sports Performance Training

Brazilian Jiu-Jitsu

Olympic Lifting

Other:

Clear selection

Activities you participate in:

(if you are an athlete, what sports do you play?)

football

baseball / fastpitch

baseketball

soccer

tennis

volleyball

wrestling

track and field

strength training

yoga / pilates

cardiovascular training

Other:

Clear selection

Please list any medical issues or previous injuries that may inhibit your training

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? *

yes

Do you have pain in your chest when you do physical activity? *

yes

Do you lose your balance because of dizziness or do you ever lose consciousness? *

yes

Do you have a bone or joint problem that could be made worse by a change in your physical activity?

yes

Clear selection

Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition? *

yes

Do you know of any other reason why you should not do physical activity? *

yes

Initial: *

Submit

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