Gym COVID-19 Liability Waiver

Gym COVID-19 Liability Waiver
Complete this form before using the gym to acknowledge COVID-19-related health screening, safety rules, and waiver terms.
Participant Information
Full Name
First NameMiddle NameLast Name
Date of Birth
MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Home Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact and Health Screening
Emergency Contact Name
First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Are you currently experiencing any COVID-19 symptoms?
If yes, please briefly describe your symptoms
Have you had recent exposure to a confirmed or suspected COVID-19 case?
If yes, please briefly describe the exposure
Have you traveled outside the local area recently, if applicable to gym policy?
Gym Safety Acknowledgment, Waiver, and Signature
Participant Signature
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