Hello there!  Thank you for taking time to complete your Client Profile and Health History Form.  All of the information you provide us with is strictly confidential, and is only used to create the best training program for you.  By clicking the submit button at the bottom of this form once you complete the information, you are confirming that you agree, understand and have read the Guest Waiver, Liability Waiver and Release Form, Health History Information Disclosure and Promotional Release Form.  

GUEST WAIVER

GUEST ACKNOWLEDGES, AGREES AND UNDERSTANDS THAT WEIGHT TRAINING, FUNCTIONAL TRAINING AND CARDIOVASCULAR TRAINING CAN BE HAZARDOUS TO SOME INDIVIDUALS AND MAY RESULT IN INJURY TO GUEST OR OTHER GUEST/MEMBERS.  GUEST FURTHER UNDERSTANDS AND AGREES THAT ALL EXERCISE INCLUDES THE USE OF WEIGHTS, NUMBER OF REPETITIONS, AND USE OF ANY AND ALL MACHINERY, EQUIPMENT, AND APPARATUS DESIGNED FOR EXERCISING SHALL BE UNSUPERVISED AND AT GUEST’S SOLE RISK.  GUEST UNDERSTANDS, WARRANTS AND AGREES THAT MEMBER IS IN GOOD PHYSICAL CONDITION, HAS NO DISABILITY, IMPAIRMENT OR AILMENT PREVENTING EXERCISE THAT WOULD BE DETRIMENTAL OR INIMICAL TO HEART, SAFETY OR PHYSICAL COMFORT.  NOTWITHSTANDING ANY CONSULTATION ON EXERCISE PROGRAMS WHICH MAY BE PROVIDED BY XPC TRAINING SYSTEMS INC’S EMPLOYEES, AGENTS AND/OR SUBCONTRACTORS.  IT IS HEREBY UNDERSTOOD THAT THE SELECTION OF EXERCISE PROGRAMS, METHODS, AND TYPES OF EQUIPMENT SHALL BE GUEST’S ENTIRE RESPONSIBILITY.  GUEST FURTHER AGREES THAT IN CONSIDERATION FOR PERMISSION TO ENTER ONTO THE PREMISES OF XPC TRAINING SYSTEMS, INC. GUEST ASSUMES ALL RISKS OF INJURY INCURRED OR SUFFERED WHILE ON AND/OR UPON THE PREMISES OF XPC TRAINING SYSTEMS, INC. AND RELEASES AND AGREES NOT TO SUE XPC TRAINING SYSTEMS, INC. ITS AGENTS, SERVANTS, ASSOCIATIONS, EMPLOYEES OR ANYONE CONNECTED WITH XPC TRAINING SYSTEMS, INC. AS A RESULT OF INJURIES OR DAMAGES, COSTS OR CAUSE OF ACTION WHICH GUEST HAS OR MAY HAVE IN THE FUTURE AS A RESULT OF INJURIES OR DAMAGES SUSTAINED OR INCURRED WHILE ON/OR UPON THE PREMISES OF XPC TRAINING SYSTEMS, INC.

LIABILITY WAIVER and RELEASE FORM

I understand that physical exercise can be strenuous and subject to risk of serious injury, and acknowledge that I have been advised to obtain a physical examination from a licensed physician prior to beginning any exercise or personal training. I agree that by participating in these physical exercise sessions or personal training or fitness coaching activities I do so entirely at my own risk. I have completed a health history questionnaire and I intend my responses thereto become part of this liability waiver and release.

I understand that the use of XPC Training Systems, Inc. (XPC) facilities, and to participate in XPC sessions and programs at the facility or at sponsored events outside the facility is at my own risk. This includes, without limitations: a. use of all amenities and equipment in the facility and at off-site locations and participation in any activity, classes, sessions, program, personal training, fitness coaching, or instruction; b. the sudden and unforeseen malfunctioning of any equipment; c. our instruction, training, supervision or dietary recommendations.

 I agree that I am voluntarily participating in these activities and the use of these facilities and premises and assume all risk of injury.

I expressly agree to release and discharge XPC Training Systems, Inc.  itself, all members of the company, my personal trainer, fitness coach, instructor, acts or omissions of third parties including but not limited to customers, contractors or employees of XPC from any and all claims, causes of action, or damages for personal injury or property damage, including attorney fees. I also agree to indemnify, protect, defend and hold harmless the released parties from and against all liabilities, claims, actions, damages to my person or personal property, including attorney fees.

 I have read this waiver and release, and fully understand its terms. I expressly agree to release and discharge XPC Training Systems, Inc., all affiliates, employees, contractors, agents, representatives from all liability and waive any right to bring legal action against the organization for any and all acts or omissions including but not limited to negligence, intentional torts, strict liability, breach of warranty and personal injury or property damage or loss. 

PROMOTIONAL RELEASE

In additional consideration of being permitted by XPC Training Systems, Inc. (XPC) to participate in its training programs and use of its facilities, I hereby permit XPC to use my name, image, and likeness for promotional purposes limited to its training programs and facilities.  XPC Training Systems, Inc.’s promotional mediums include but are not limited to print, radio, video, television and the internet.  I acknowledge that I have read this release and waiver and fully understand its contents.  I have been fully and completely advised of the potential dangers incidental to engaging in the activity and instruction of physical training and I am fully aware of the legal consequences of signing this release.  I voluntarily agree to the terms and conditions stated above.

Health History Information Disclosure

I understand this Health History Information is for the purpose of helping me better understand any potential risks associated with a workout program.  I understand that consulting a physician for approval is advised prior to beginning an exercise program.  I understand this information is to be held strictly confidential and used only in case of medical emergency.  I acknowledge that XPC Training Systems, Inc. is relying on my answers set forth herein in order to develop the fitness program that is best suited to my needs.  I understand that I have a continuing obligation to advise XPC Training Systems, Inc. of any material changes to the answers set forth herein.  My electronic signature signifies that all the information below is true to the best of my knowledge and any information left unanswered has been done so intentionally.


Please complete Client Profile & Health History Form and Submit

Client Profile
Name *
Name
Date of Birth (xx/xx/xxxx) *
Date of Birth (xx/xx/xxxx)
Address *
Address
Cell Phone *
Cell Phone
Emergency Contact
Emergency Contact
Emergency Contact Phone
Emergency Contact Phone
What areas of your Health & Fitness would you like to see improved: *
Health History Questionnaire
In order for us to know you better and design a fitness program that is best for you, please provide the following health history information. All information is strictly confidential.
Has a physician placed any restrictions on your physical activity - now or in the past?
Do you have, or have you ever had problems with:
Have you had any past injuries to:
Disclosure Agreement/Electronic Signature
I agree to the terms of the Guest Waiver that I have read *
I agree to the terms of the Liability Waiver and Release Form that I have read *
I agree to the terms of the Promotional Release, and give Parisi XPC permission to use my name, image and likeness for promotional purposes. (including Social Media posts, website and print testimonials) *
I agree to the Health History Information Disclosure *