Waiver

Gym & Fitness Liability Waiver

First name

Last name

Are you cleared to participate in physical activity?

Yes

Do you have any pre-existing medical condtions, restrictions or injuries that we should know about?

Are you 18 years or older?

Yes

Initials (Parent/Guardian if not 18 years old)

Birthday

I acknowledge and agree that photos and/or videos may be taken of me and/or my child during program activities. I give permission for these images to be used by DöRū Ftiness for promotional purposes, including but not limited to Instagram, Facebook, the program website, and other marketing materials.

I understand that no names or personal identifying information will be shared without separate written consent.

I understand that media will be used respectfully and in a way that reflects the mission and values of DöRū Fitness.

I hereby acknowledge this release from liability for accidental injury or illness which I may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

Get in Touch

5 Cross St., Topsham ME 04086

202-660-2546

540-449-1066

Doruwolfpack@gmail.com