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Has your doctor ever said you had heart trouble? YesNo
Do you frequently have pains in your heart and chest? YesNo
Do you often feel faint or have or spells of severe dizziness? YesNo
Has your doctor ever said your blood pressure was too high? YesNo
Has your doctor ever told you that you had a bone or joint problem such as arthritis, that has been aggravated by exercise, or might be made worse by exercise? YesNo
Is there any good physical reason not mentioned here why you should not follow an exercise program even if you wanted to? YesNo
Are you over the age of 65 and not accustomed to vigorous exercise? YesNo
The undersigned guest agrees that all use of Dakota Personal Training Facilities, services, programs, and classes shall be undertaken at his/her/their risk and Dakota Personal Training shall not be liable for any injuries, accidents, or death occurring to the guest, arising either directly or indirectly out of utilizing Dakota Personal Training facilities, services, programs or classes. The guest, for himself/herself/themself and on behalf of his/her/their executors, administrators, heirs and assigns do hereby expressly release, discharge, waive, relinquish and covenants not to sue Dakota Personal Training, officers, and agents for all such claims, demands, injuries, damages or cause of action with respect to the use of Dakota Personal Training facilities, services, programs, and classes.
The undersigned guest declares that they have completed the enclosed medical questionnaire as a guest of Dakota Personal Training and that they declare they are physically able to participate in physical activity. The undersigned guest declares that Dakota Personal Training has advised the guest to obtain medical clearance in the event that the answer is YES to any of the medical history questions, or if they are unsure of their physical health. The undersigned guest declares that he/she/they are physically capable of physical activity at Dakota Personal Training.
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