Gym Waiver & Questionnaire

Fill out our Updated Gym Waiver & Questionnaire Before your first workout, please!

Participant info

Emergency contact info

Health history Questionnaire

Common sense is your best guide in answering these questions. Please read them carefully and check either "Yes" or "No" as it applies to you.
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
In the past month, have you had chest pain when you were NOT doing physical activity?
Do you lose your balance because of dizziness or do you ever lose consciousness?
Do you have a bone or joint problem that could be made worse by a change in your physical activity?
Are you now or have you ever been a diabetic?
Is your doctor currently prescribing drugs (for example, water pills) for high blood pressure or a heart condition?
Are you pregnant or have you been pregnant in the last 3 months?
Have you ever suffered from low back pain?
Has a doctor ever told you that your blood pressure was too high?
Are you currently taking any other prescription medication?

ACKNOWLEDGMENT OF RISKS

I, the undersigned, understand and acknowledge that the use of Sweet Owen Barbell LLC's equipment and facilities and participation in its activities involves risks of injury, including but not limited to: bodily injury, strains, fractures, partial and/or total paralysis, death or other ailments that could cause serious disability.

These risks may result from the use of the equipment or facilities, from participation in activities, from the acts of myself or others, or from the unavailability of emergency medical care. I understand that there may be other risks not known to me or not reasonably foreseeable at this time.

ASSUMPTION OF RISK

I HEREBY ASSUME ALL RISK OF INJURY OR LOSS CONNECTED WITH MY PARTICIPATION IN ACTIVITIES AT SWEET OWEN BARBELL LLC AND/OR USE OF THE FACILITY AND EQUIPMENT. I understand and acknowledge that Sweet Owen Barbell LLC is not responsible for property that is lost, stolen, or damaged while in, on, or about the premises.

RELEASE OF LIABILITY AND INDEMNIFICATION

I, FOR MYSELF AND ON BEHALF OF MY HEIRS, ASSIGNS, PERSONAL REPRESENTATIVES AND NEXT OF KIN, HEREBY RELEASE AND HOLD HARMLESS Sweet Owen Barbell LLC, its owners, officers, officials, agents, employees, contractors, other participants, and, if applicable, owners and lessors of premises ("Releasees"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, LOSS OR DAMAGE to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

I agree to indemnify and defend Sweet Owen Barbell LLC against all claims, causes of action, damages, judgments, costs or expenses, including attorney fees and other litigation costs, which may arise as a result of my participation in activities at Sweet Owen Barbell LLC and/or use of the facility and equipment.

MEDICAL AUTHORIZATION

In the event I am unable to do so, I hereby give my consent to have emergency medical personnel and/or a physician at the nearest medical facility provide me with medical assistance and/or treatment as deemed necessary.

FITNESS CERTIFICATION

I hereby certify that I am in good health, physically able to undertake and engage in physical exercise and suffer from no known physical defect or condition that would render such participation dangerous. I agree to promptly notify Sweet Owen Barbell LLC of any changes in my health status.

RULES AND REGULATIONS

I agree to comply with all rules and regulations of Sweet Owen Barbell LLC now in force or that may be adopted in the future. I understand that violation of these rules may result in the suspension or cancellation of my membership.

BILLING AUTHORIZATION

By signing this waiver, I agree to allow Sweet Owen Barbell LLC to withdraw funds from the credit/bank account of my choice with electronic funds transfer (EFT) to pay monthly dues until the membership is terminated.

A 30-DAY CANCELLATION NOTICE IS REQUIRED UPON TERMINATION OF MEMBERSHIP. NO REFUNDS OF ANY KIND.

UNDERSTANDING AND AGREEMENT

I HAVE READ THIS WAIVER AND RELEASE OF LIABILITY AND FULLY UNDERSTAND ITS TERMS. I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Click Below
Submit
Thank you for filling out the waiver! Check your email for more information about the gym and when you can workout at S.O.B. Gym before our public open date in June.
Oops! Something went wrong while submitting the form.