CrossFit Thin Air
Medical Disclosure and Waiver of Liability
NOTE: You are filling out and signing BOTH SIDES of this document!
Regular physical activity is fun and healthy, and increasingly more people are starting to become more active
every day. Being more active is very safe for most people. However, some people should check with their
physician before they start becoming more physically active. Please complete this form as accurately and
completely as possible. PLEASE PRINT!
Name
Gender (M/F)
Phone
Email
Current Fitness
Level: Rate
yourself, (1-10),
list any
perceived
weaknesses if
you wish
Birthdate
(mm/dd/yyyy)
Approx.
Weight (lbs)
Approx. Height
(ft/in)
Mailing
Address
Top Three
Fitness Goals:
Please mark YES or NO to the following:
YES NO
Has your doctor ever said that you have a heart condition and recommended only medically
supervised physical activity?
Do you frequently have pains in your chest when you perform physical activity?
Have you had chest pain when you were not doing physical activity?
Have you had a stroke?
Do you lose your balance due to dizziness or do you ever lose consciousness?
Do you have a bone, joint or any other health problem that causes you pain or limitations that
must be addressed when developing an exercise program (i.e. diabetes, osteoporosis, high
blood pressure, high cholesterol, arthritis, anorexia, bulimia, anemia, epilepsy, respiratory
ailments, back problems, etc.)?
Are you pregnant now or have given birth within the last 6 months?
Do you have asthma or exercise induced asthma?
Do you have low blood sugar levels (hypoglycemia)?
Have you had a recent surgery?
If you have marked YES to any of the above, please elaborate below (use the other side for more room if
needed):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Do you take any medications, either prescription or non-prescription, on a regular basis? Yes/No
What is the medication for? How does this medication affect your ability to exercise or achieve your fitness goals?
_________________________________________________________________
Please note: If your health changes such that you could then answer YES to any of the above questions, tell your
trainer/coach. Ask whether you should change your physical activity plan.
I have read, understood, and completed the questionnaire.
Any questions I had were answered to my full satisfaction.
Signature: _____________________________________________
Date:_______________
Printed Name: __________________________________________
Page 1 of 2 Pages (This is a TWO SIDED FORM)
CrossFit Thin Air
Medical Disclosure and Waiver of Liability
NOTE: You are filling out and signing BOTH SIDES of this document!
This release is entered into between the undersigned and Thin Air Fitness, LLC, (doing business as and
henceforth referred to as CrossFit Thin Air) its officers, affiliates, trainers, executors and owners of the physical
property from which CrossFit Thin Air programs operate. The purpose of CrossFit Thin Air is to provide fitness
instruction and coaching for various levels of athletes/individuals.
I hereby acknowledge that I have had sufficient explanation of and agree to the following:
1. CrossFit Thin Air staff members are not physicians and are not trained in any way to provide medical
diagnosis, medical treatment, or any other type of medical advice.
2. The CrossFit Thin Air program and approach is just one of many different types of tools for increasing and/or
maintaining fitness, and CrossFit Thin Air makes no guarantee of any specific results from training.
3. I have been told if I feel tired, feel pain or feel out of the ordinary in any way either related to activities or
training with CrossFit Thin Air, or otherwise, I should seek medical advice at once.
4. I understand that videography and photography may be taken at any time which may appear on TV, web video,
print or any other digital format. When possible, participants in CrossFit Thin Air programs will be told in advance
of the days in which any photography or videography will be done. "Before & After" photos will not be used for any
promotional purposes unless written authorization is granted.
5. I acknowledge that I have received a description of the kinds of activities to expect at CrossFit Thin Air, and
that boot camps, aerobic classes, running, weight training, body weight training, and any other related activities
are an extreme test of one's mental and physical limits and carry with it potential for damage or loss of property,
serious injury and death. I further agree to assume the risks of participating in these types of events and activities,
including the inherent dangers of the natural elements, and that I understand it is my responsibility to consult with
a medical professional for advice or to answer any questions that I might have before participating in these types
of activities. I expressly waive, release, discharge and agree not to sue from any liability of death, disability,
personal injury, or action of any kind resulting from participating in activities at CrossFit Thin Air.
I understand that this agreement is valid indefinitely. With a full and complete understanding of this agreement,
I enter into this agreement freely and voluntarily and agree that it is binding on me, my family, my friends, my
legal representatives, and any other person acting on my behalf. I certify that I am mentally competent to enter
this agreement. If a court of competent jurisdiction should hold one or more sections of this agreement invalid,
such holding shall not affect the remainder of the agreement nor the context in which such sections held invalid
may appear, except to the extent that an entire section may be inseparably connected in meaning and effect with
the section so held invalid.
Signature: _____________________________________________
Date:_______________
Printed Name: __________________________________________
Parent or Guardian must sign if Participant is under 18:
Signature: _____________________________________________
Date:_______________
Printed Name: __________________________________________
Page 2 of 2 Pages (This is a TWO SIDED FORM)