Fitness Campaign Shoot Waiver Form

Fitness Campaign Shoot Waiver Form
Participant Information
Full Name
First NameLast Name
Fitness Level / Experience
Date of Birth
MonthDayYear
Date
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Emergency Contact
Relationship to Participant
Emergency Contact Name
First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Health & Fitness Information
Current Health Conditions / Injuries
Allergies
Medications
Participation Consent
I, the undersigned, voluntarily agree to participate in the Fitness Campaign Shoot organized by X Health Center. I acknowledge that participation involves physical activity, which may include exercises, fitness demonstrations, or other activities that carry inherent risks of injury.
I confirm that I am physically fit and do not have any medical conditions that would prevent me from safely participating. I understand that it is my responsibility to consult a physician if I have any concerns regarding my ability to participate.
By signing this form, I grant X Health Center the right to photograph, video record, and use my likeness, name, and performance in all media formats for promotional, marketing, and advertising purposes without further notice or compensation.
Participant Signature
Clear
Should be Empty:

Participant Information