Professional Touch Fitness

P.O. Box 955
Philadelphia, PA 19105
484-410-8007
Email: cspnow@yahoo.com
www.sgtnate.com

REGISTRATION AND AGREEMENT FORM

Name:________________________________________________

Date of Birth________________

 

Home address: ______________________________________________________

City: ________________________________

 

State: _____________ Zip: ____________

Telephone: ____________________________

work ______________________________

e-mail:  _______________________________

Male: __ Female: __ Married: __ Single: __

 

How did you hear of Program: ______________________

PLAN:  A __ B __ C __ D __

TERMS OF AGREEMENT:

This registration (The agreement) represents a legal agreement and is the only agreements as to
membership rights and privileges. This agreement cannot be modified in any way except in writing
signed by the member and the owner of Professional Touch Fitness, Nathaniel   J. Griffin.  

PERSONAL WAIVER:

I understand that when I use Professional Touch Fitness and its services, I do so at my own risk. I agree
to assume all risk of illness, injury, and loss to myself and or property including theft of such property. I
understand that the use of the program is entirely voluntary and at my total, personal discretion.

MEMBERSHIP RULES:

By signing this agreement, I agree to abide by Professional Touch Fitness rules and regulations as given
throughout the program.
 
 
MEDICAL REFERAL:

It is recommended to check with your doctor before starting any exercising or diet program.  Have your
doctor fill out the form. If you choose not to have it filled out, draw a line through it then initial it.

Physician’s name: _____________________________________________

____________________________________ (patient’s name) has applied to participate in an exercise test and program.

Active participation in this program requires your medical clearance.

Please complete the form below and indicated advised limitations if any.

Patient: ____________________________________________

Date: _____________________________

Address: ______________________________________

City: _________________ ST. _______________

Phone: _______________________________

 

Date of Birth: ____________ M/F: ______
Disposition:

No participation in: ____________________________________________________________________

Limited participation in: _________________________________________________________________

Requires: _____________________________________________________________________________
                  _____________________________________________________________________________

Full participation in: ____________________________________________________________________
 

Signed: _____________________________________________

 

Date: ____________________________
 
 
 
 
 
 
 
 
 
LIABILITY RELEASE FORM:
I, _________________________________________________, certify and acknowledge:
That Nathaniel Griffin advised me prior to commencement of my participation in the Ranger Training
program that I should consult a licensed physician prior to commencement of participation in order that
my physical condition and suitability for physical fitness training could be professionally and
independently evaluated.
That Nathaniel Griffin has advised me, that prior to my commencement of participation in this group
health and fitness program, that such participation involves vigorous and high intensity exercise which
could result in physical injury.
That I freely and knowingly assume the risk inherent in participation in the group health and exercise
program, which risks have been explained to me by Nathaniel Griffin, and I hereby waive my rights,
claim, or cause of action against Professional Touch Fitness, its officers, directors, employees, and
agents, and release them from any liability for injury, cost, damage, expense, or claim which I or anyone
on my behalf might have direct or indirect result of my participation in the group health and exercise
program.   
That I have read the foregoing, understand and agree with each of the foregoing, and have received a
copy of this Agreement on the date below.
 
__________________________________________    

                       ___________________________
Signature   

 

                                                                                                     Date