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Medical Questionnaire

Please fill out the following form to help us understand your physical condition.

THIS IS A RELEASE. PLEASE READ BEFORE SIGNING. I hereby represent and stipulate that 1) have been fully advised of the existence, nature, risks, and possible consequences of exercise; 2) I have been given the opportunity to ask any questions concerning the existence, nature, and extent of such risks of injury; 3) I have been urged to seek independent medical advice from a licensed physician regarding the risks of exercise before participating in same; 4) I have represented to Susan Alonso that I am physically sound, in good health, and do not have any physical or mental condition, impairment, or limitations that would make it unsafe, unhealthy, or unwise for me to exercise or participate actively in exercise classes. I agree that all exercises and lessons shall be undertaken at my sole risk and that Susan Alonso shall not be held liable for injuries, losses or damages to my person or property arising out of, or connected with the use of the services of Susan Alonso. I do hereby forever release, waive, discharge and covenant not to sue Susan Alonso from all such causes of action to the fullest extent allowed by law. Except in the case of gross negligence or malpractice, I or my representative(s) agree to full release and hold harmless Susan Alonso from and against any and all claims or liability of whatsoever kind or nature arising out of or in connection with my session(s). I agree to stop exercising if I feel weak, faint, nauseated, or unduly tired, uncomfortable, or pain. If under 18 years old, parent/guardian must sign: I give my permission for my child to participate in exercise classes, and consent to the above terms and conditions.

Thanks for submitting!

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