Release & Waiver For Personal Fitness Training Program Page 2

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I hereby represent that I have carefully read, understand and agree to the contents of this Release and Waiver and
sign the same voluntarily and of my own free will.
CAUTION: READ THIS DOCUMENT IN FULL BEFORE SIGNING
NAME: ______________________________________________________________________________
ADDRESS: _______________________________ CITY ________________________ ZIP___________
TELEPHONE: (home) ____________________ (work) ________________________
Contact in Emergency:
NAME_____________________________________PHONE____________________________
DATE_______________________
Signature ____________________________________________________
(Adult 18 and Over)
Signature______________________________________
Print Name: ___________________________________
(Parent/Guardian if Participant is under 18 Years of Age)
Name of Participant under 18 Years of Age: _________________________________

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