Fitness Instructor Waiver And Liability Release Form
Complete this form to provide your participant details, emergency contact, participation date, and waiver acknowledgment for a fitness instructor session.
Participant Information
Participant Full Name
*
First Name
Middle Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Emergency Contact and Participation Details
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Planned Class/Session Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Waiver Acknowledgment and Signature
Participant Signature
*
Submit
Submit
Should be Empty: