How did you hear about us?
2. Have you exercised in the past 6 months?
3. Please Indicate any diease or illness you may have:
Other health concerns not listed that may affect your ability to participate in a nutrition or fitness program:
4. Are you currently taking any medications? If yes, please specify
5. Are you or do you expect that you may be pregnant?
6. Do you or have you ever had:
I agree to hold VIP Fitness Rochester, PIT Fitness, & RL Gordon Investments and all of their employees, agents, and members free from any and all injuries, losses, damges, and liability that cn occur from my participation in activity & presence at the facility. I also agree to be photographed/videotaped & the relase the use of photographs/videos for public use in any publications, advertisements, and other marketing tools used by the facility. I agree that to my knowledge I am able to safely partcipate in any physical activity.
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