*Welcome To Get Fit NH's Athlete Academy
*
Profile and Release Form  

Cr8 Health & Fitness, LLC/Get Fit NH is committed to protecting your privacy. We do not sell, trade or rent your personal information to others. Your confidentiality is very important to us, and information collected is used solely to allow us to serve you better.
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General Information

 
Athlete's First Name *

 
Athlete's Last Name *

 
Parent/Legal Guardian's Name and Phone Number *

 
Street Address *

 
City *

 
State *

 
Zip Code *

 
Cell Phone # *

 
Birth Date *

 
Grade *

 
School *

 
Coach

 
Club Team

 
Coach

 
Specific area(s) you are looking to improve *

Prioritize top 3

 
How did you hear about us? *


 
Sport Played *


 
Position and/or Event for each sport

 
Health & Medical History

Please answer all questions, and explain all "Yes" answers and approximate date(s) of occurrence.
 
Do you currently have a injury or have you had any injuries in the last 6 months? *

     
 
Please describe the injury, the date it occurred and treatment sought.

 
Has the injury healed? *

     
 
Did you/are you getting treatment for this injury?

     
 
Name, title and phone # of medical professional who treated (athletic trainer, chiropractor, physician, surgeon, etc.)

 
Are you currently under a doctor's care? *

 
Have you ever had surgery? *

 
Are you currently taking any medications? *

 
Do you have allergies? *

 
Have you ever been dizzy or fainted after/during exercise? *

 
Have you ever had chest pains after/during exercise? *

 
Have you ever had high blood pressure? *

 
Do you have a heart murmur or other heart condition? *

 
Have you ever had a head injury, been knocked out or unconscious? *

 
Have you ever had a seizure? *

 
Have you ever had a stinger, burner, or pinched nerve? *

 
Do you ever have any trouble breathing during or after exercise? *

 
Do you have any skin problems (rashes, itching)? *

 
Do you wear glasses, contacts, or protective eyewear? *

 
Have you had any problems with your eyes or vision? *

 
Do you have only one working organ of usually paired organs (eye, kidney, etc)? *

 
Have you had any other medical problems (asthma, diabetes, etc)? *

 
Any special precautions, instructions or medical information to ensure your safety? *

 
Have you ever sprained, broken, dislocated, had repeated pain or swelling of any bones or joints? *

 
Do you know of any other reason you should not exercise or increase your physical activity? *

     
 
If Yes, please describe

 
Primary Physician Name

 
Primary Physician Phone

 
Approval of Health & Medical History *

I certify that I understand the forgoing questions and my answers are true and complete. I also understand that if this information changes in any way in the future, it is my responsibility to notify my trainer, and that I assume the risk for any changes in my medical condition that might affect my ability to exercise.

I acknowledge that it is recommended to consult a physician prior to starting any health/fitness/nutrition program, and that only a qualified health care provider is able to diagnose and prescribe treatment for specific health conditions.

I agree to the above statement
     
 
Images and Video *

I understand that I may appear in images or video relating to my participation in training and events, and give full permission to Cr8 Health & Fitness, LLC to use these royalty-free in advertisements, promotions or commercials.
     
 
Parent/Guardian Approval to Train
*

For and in consideration of the Athlete named above for whom I am the legal guardian of, being accepted into Get Fit NH, I state and promise as follows: My child is mentally and physically capable of participation in all training. I understand that any evaluation or assessment of my child’s physical fitness and any recommendation of activities made by anyone at the facility shall not be a substitute for obtaining such evaluation, assessment or recommendation from my child’s physician before participating in any of the training activities. My child’s participation is voluntary and I voluntarily permit my child to participate. My child’s participation in training is an inherently dangerous activity and that the risk of participation include, but are not limited to, falls, collisions, cuts, broken bones, strains, torn ligaments, concussion and while highly unlikely, possible death. I hereby, for myself, my child, our heirs, administrators, executors, personal representatives and assigns, forever waive, release and discharge any and all rights to claims for damages and losses, whether monetary or otherwise compensatory, that I or my child may have against: (i) Cr8 Health and Fitness, LLC dba Get Fit NH and its directors; (ii) executive directors, owners, managers, officers, employees, members, representatives, and agents; (iii) all coaches, participants, organizers, supervisors, planners, and volunteers; and (iv) all city, county and state governments for any and all injures sustained by me or my child arising out of association with, entry in, or participation in the training and any and all training activities. I understand and agree that medical or other services rendered to my child by or at the insistence of any of the above parties is not an admission of liability to provide or continue to provide any such services and is not a waiver by any said parties of any hereunder. I also acknowledge that should my child require transport to a medical facility, I must pay for such transportation and any treatment period. I further agree now and forever to hold the above named and unnamed parties harmless and indemnify them for all claims, damages, judgments and costs of whatever nature and form. Get Fit NH recommends that your child be examined by his/her physician before participation in any and all training activities. I hereby approve of my child’s participation in Get Fit NH training. If my child has a history of heart disease, he/she will consult a physician prior to participating in any training activities. I hereby approve of my child’s participation at Get Fit NH and their training and certify that he or she is in good health and able to participate in any activities. I understand, should an emergency condition arise, an Get Fit NH representative will make their best effort to contact the above referenced contact person(s) during the physical exam.
For and in consideration of the Athlete named above for whom I am the legal guardian of, being accepted into Get Fit NH, I state and promise as follows: My child is mentally and physically capable of participation in all training. I understand that any evaluation or assessment of my child’s physical fitness and any recommendation of activities made by anyone at the facility shall not be a substitute for obtaining such evaluation, assessment or recommendation from my child’s physician before participating in any of the training activities. My child’s participation is voluntary and I voluntarily permit my child to participate. My child’s participation in training is an inherently dangerous activity and that the risk of participation include, but are not limited to, falls, collisions, cuts, broken bones, strains, torn ligaments, concussion and while highly unlikely, possible death. I hereby, for myself, my child, our heirs, administrators, executors, personal representatives and assigns, forever waive, release and discharge any and all rights to claims for damages and losses, whether monetary or otherwise compensatory, that I or my child may have against: (i) Cr8 Health and Fitness, LLC dba Get Fit NH and its directors; (ii) executive directors, owners, managers, officers, employees, members, representatives, and agents; (iii) all coaches, participants, organizers, supervisors, planners, and volunteers; and (iv) all city, county and state governments for any and all injures sustained by me or my child arising out of association with, entry in, or participation in the training and any and all training activities. I understand and agree that medical or other services rendered to my child by or at the insistence of any of the above parties is not an admission of liability to provide or continue to provide any such services and is not a waiver by any said parties of any hereunder. I also acknowledge that should my child require transport to a medical facility, I must pay for such transportation and any treatment period. I further agree now and forever to hold the above named and unnamed parties harmless and indemnify them for all claims, damages, judgments and costs of whatever nature and form. Get Fit NH recommends that your child be examined by his/her physician before participation in any and all training activities. I hereby approve of my child’s participation in Get Fit NH training. If my child has a history of heart disease, he/she will consult a physician prior to participating in any training activities. I hereby approve of my child’s participation at Get Fit NH and their training and certify that he or she is in good health and able to participate in any activities. I understand, should an emergency condition arise, an Get Fit NH representative will make their best effort to contact the above referenced contact person(s) during the physical exam.
     
 
Parent/Legal Guardian's Digital Signature *

By typing your name into this field, you are hereby providing a digital signature.

Please Type Your Name
 
Athlete's Digital Signature *

By typing your name into this field, you are hereby providing a digital signature.

Please Type Your Name
 
Date Submitted *

Thank-You for filling out and submitting your profile and release form. After submitting this form you will be sent an email with our Training and Liability Waiver. This document must be completely filed out and signed by both the athlete and the parent/legal guardian of the athlete BEFORE assessment and training can begin. We will call you ASAP after receiving this form to go over your athlete profile and get you setup to begin training. Let's do this!
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