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Olympic Lifting Education
Series
Snatch Workshop
Snatch Accessory
Workshop
Clean Workshop
Clean Accessory
Workshop
Jerk Workshop
Jerk Accessory Workshop
Select Location
Franklin
Topsfield
RWL Weightlifting, Inc. | www.rwlweightlifting.org
RWL Weightlifting, Inc.
72 Grove Street Suites 1 & 2
Franklin, MA 02038
www.rwlweightlifting.org
info@rwlweightlifting.org
Waiver, Release, and Assumption of Risk Form
I,
[write name]
, have volunteered to participate in a fitness program provided to me by RWL
Weightlifting, Inc., which may include, but may not be limited to, Olympic weightlifting, strength training and aerobic or
cardiovascular exercise. In consideration of the agreement to instruct and train me, I do here now and forever release and
discharge and hereby hold harmless the Coach and his/her respective agents, heirs, assigns, contractors, and employees
from any and all claims, demands, damages, rights of action or causes of action, present or future, arising out of or
connected with my participation in this or any exercise program including any injuries resulting there from. THIS WAIVER
AND RELEASE OF LIABILITY INCLUDES, WITHOUT LIMITATION, INJURIES WHICH MAY OCCUR AS A RESULT OF (1)
EQUIPMENT BELONGING TO THE COACH OR TO MYSELF THAT MAY MALFUNCTION OR BREAK; (2) ANY SLIP, FALL,
DROPPING OF EQUIPMENT; (3) AND/OR NEGLIGENT INSTRUCTION OR SUPERVISION.
I,
[write name]
, have been informed of, understand, and am aware that any exercise program,
whether or not requiring the use of exercise equipment, is a potentially hazardous activity. I also have been informed of,
understand, and am aware that any exercise and/or fitness activities involve a risk of injury, as well as abnormal changes in
blood pressure, fainting, and a remote risk of heart attack, stroke, other serious disability or death, and that I am voluntarily
participating in these activities and using equipment and machinery with full knowledge, understanding and appreciation of the
dangers involved.
I hereby agree to expressly assume and accept any and all risks of injury, regardless of severity, or death. I have been
advised that an examination by a physician should be obtained by anyone prior to commencing a fitness and/or exercise
program, or initiating a substantial change in the amount of regular physical activity performed.
If I,
[write name]
, have chosen not to obtain a physicianʼs consent prior to beginning this fitness
program, I hereby agree that I am doing so solely at my own risk. In any event, I acknowledge and agree that I assume the
risks associated with any and all fitness related activities and/or exercises in which I participate.
I ACKNOWLEDGE THAT I HAVE THOROUGHLY READ THIS FORM IN ITS ENTIRETY AND FULLY UNDERSTAND THAT IT
IS A RELEASE OF LIABILITY. BY SIGNING THIS DOCUMENT, I AM WAIVING ANY RIGHT I OR MY SUCCESSORS MIGHT
HAVE TO BRING A LEGAL ACTION OR ASSERT A CLAIM AGAINST RWL WEIGHTLIFTING, INC, AND ALL OF IT’S
SUBCONTRACTORS FOR YOUR NEGLIGENCE OR THAT OF YOUR EMPLOYEES, AGENTS, OR CONTRACTORS.
PHOTOGRAPHY & VIDEO
RWL Weightlifting, Inc. may use photography and video during regular classes and training events. These photos may be
used in email campaigns or advertisements. If you DO NOT want your image to appear in print or in video, please initial
.
here:_________
This form is an important legal document that explains the risks you are assuming by beginning an exercise program. It is
critical that you have read and understand this document completely. If you do not understand any part of this document, it is
your ultimate responsibility to ask for clarification prior to signing it.
Participantʼs signature
Please print name
Date
Parent or legal guardian
(if participant is under age eighteen)
Please print name
Date
RWL Weightlifting, Inc.
72 Grove Street Suites 1 & 2
Franklin, MA 02038
www.rwlweightlifting.org
info@rwlweightlifting.org
Health & Medical History
Physical activity should not pose any problem or hazard to the majority of people. The following questions are
designed to identify the small number of adults for whom physical activity might be inappropriate or those who
should seek medical advice prior to initiating a fitness program or other change in their physical activity levels.
Yes
No
Are you over age 55 and/or not accustomed to vigorous exercise?
Have you ever been diagnosed with Type I or Type II Diabetes?
Do you have any reason to suspect that you might now be pregnant, or have
you been pregnant within the last 3 months?
Have you had any major or minor surgery in the past 3 months?
Have you been hospitalized in the last 2 years? If so, when and for what
reason?
Are you currently, or have you in the past, ever seen a chiropractor or physical
therapist for any condition? If yes, when and for what condition?
Do you ever experience unexpected shortness of breath, or labored breathing,
with or without pain? If yes, describe under what conditions.
Do you currently, or have you ever, experienced unexplained heart palpitations
or been diagnosed with a heart murmur or irregular heartbeat?
Have you ever been diagnosed with high blood pressure? If yes, when?
Do you know what your blood pressure normally is? If yes, please state:
Do you currently smoke? If yes, how many cigarettes per day?
Did you ever smoke? If yes, how long ago did you quit?