Waiver & Release Step 1 of 3 33% Date* Date Format: MM slash DD slash YYYY Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Enter Email Confirm Email Birthdate* Date Format: MM slash DD slash YYYY Emergency Contact* First Last Contact Phone Number* Gender*FemaleMalePrefer Not to AnswerFitness Goals*Height*Weight*Health or Physical RestrictionsHealth History Select All High Blood Pressure Arthritis Knee Pain High Cholesterol Back Pain Surgeries Other Check ALL that applyList Surgeries*Explain "Other"*Physical Activity Questionnaire (PAR-Q) Has your doctor ever said you have heart trouble? Do you frequently have pains in your heart and chest? Do you often feel faint or have spells of severe dizziness? Has your doctor ever told you that you have bone or joint problems, such as arthritis that has been aggravated by exercise or might be made worse with exercise? Is there a good physical reason not mentioned here why you should not follow an activity program even if you want to? Are you over the age of 65 and not accustomed to vigorous exercise? Please check ALL that apply This iframe contains the logic required to handle Ajax powered Gravity Forms.