Name
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First Name
Last Name
Email
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Phone
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(###)
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I will be training
At a commercial gym
At a powerlifting gym
At a weightlifting gym
At a CrossFit gym
At home/home gym
At Drew Murphy Strength
Other
Please select all equipment you will have access to
Please list any other equipment you will have access to
What are your training goals?
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The more specific you can be here the better.
What is your current 1RM squat?
What is your current 1RM bench press (no pause)?
What is your current 1RM deadlift?
Do you deadlift conventional, or sumo, or both?
What is your current 1RM overhead press?
How many consecutive push ups can you do?
How many consecutive pull ups can you do?
Please list any injury history, major surgeries, and health conditions that would affect your training and that I should be aware of
Please review and sign below.
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In consideration of being permitted to engage in the following activity - participation in an exercise program (hereinafter referred to as the “Activity”) coordinated by Drew Murphy Strength and Fitness of 411 W. Greenfield Drive Unit 1B, Tiffin, IA 52340 - I acknowledge and agree to, on my own behalf, and on behalf of my personal representatives, heirs, assigns, executors, administrators and next of kin, as follows: I am aware and acknowledge that injury or death may result from my participation in the Activity and from the use of the premises and facilities where the Activity is located or is to occur, or if premises and facilities are not an applicable description, the general area where the Activity is to occur, and the use of any machinery, equipment or apparatus located therein or thereon (collectively the “Activity Premises”). Upon entering the Activity Premises, I will inspect the same and my observation and my engagement, participation and/or involvement in the Activity shall constitute an acknowledgement that I find and accept them to be safe and reasonably suited for their intended purpose. I hereby release Drew Murphy Strength and Fitness of 411 W. Greenfield Drive Unit 1B, Tiffin, IA 52340 and (collectively, the “Releasees”) from and against any and all liability for any loss, damage, injury, expense, demand or cause of action that I may suffer whether with respect to personal injury, death, damage to or destruction of property, theft or otherwise, which may arise as a result of my presence in, upon or about the Activity Premises or my use of the Activity Premises. I will indemnify and hold harmless the Releasees, collectively and individually, from any and all losses, liabilities, damages, demands, costs, causes of action and expenses that they may incur, for any reason whatsoever, which may arise as a result of my participation in the Activity, and my presence in, upon or about the Activity Premises.
Please check the box below. After submitting you will be redirected to set up payment.
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I acknowledge that I have reviewed and signed this Waiver of Liability, and have been given reasonable opportunity to discuss this with my legal counsel. Further, I acknowledge that I fully understand the terms of this Waiver of Liability and that I have signed it freely and voluntarily without any inducement, assurance, guarantee or oral representation being made.
