Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Date of Birth * MM DD YYYY Are you insured for any of the following services? (Check all that apply) * Physiotherapy Chiropractic Care Massage Therapy Who is your insurance provider? * Emergency Contact Phone * (###) ### #### Emergency Contact Name First Name Last Name Terms & Conditions * Guest Health Warranty: Quick Fitness shall not be liable for any injury arising out of the guest's disability, impairment, and/or aliment preventing him or her from engaging in active of passive exercise, or that would be detrimental or adverse to such person's health, safety, and/or physical condition if he or she chooses to participate. Each member and guest should be aware of his/her medical history and should consult with a physician prior to engaging in exercise or continuing to exercise if a medical condition appears to be developing/has developed. activity/function that is operated, arranged, or sponsored by Quick Fitness. It shall be the obligation of the guest to pay for any costs involved upon presentation of a statement thereof. Any and all use of equipments of Quick Fitness by the guest shall be at such person's own risk, and Quick Fitness shall not be liable for any injuries or damages to such person or the property of such person or be subject to any claim, demand , injury, and/or damages. The guest or anyone or anyone on behalf of the guest's personal representative, heirs, administrators, assings, and successors does here by expressly forever release and discharge at Quick Fitness, its successors, and assings, as well as its officers, agents, and employees from all such claims, demands, actions or cause of actions. Months where a member does not use the gym will not be refunded/ added on or extended to a membership. By checking this box I agree to the terms and conditions above & acknowledging that this is your signed agreement. Thank you! We look forward to seeing you! You will be redirected to fill out a quick Physical Readiness Questionnaire. Guest Info + Waiver Agreement