SPRING Session Registration *

Please select the classes from our 4-week spring session that you are willing to commit to. You are encouraged to pick multiple sessions :)

Saturday, May 5th, Noon-1:00PM

Saturday, May 12th, Noon-1:00PM

Saturday, May 19th, Noon-1:00PM

Saturday, May 26th, Noon-1:00PM

Name *

First Name

Last Name

Are you over the age of 18? *

Yes

No

Phone *

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Name *

Must be over the age of 18

First Name

Last Name

Phone *

(###)

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1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? *

Yes

No

2. Do you feel pain in your chest when you do physical activity? *

Yes

No

3. In the past month, have you had chest pain when you were not doing physical activity? *

Yes

No

4. Do you lose your balance because of dizziness or do you ever lose consciousness? *

Yes

No

5. Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity? *

Yes

No

6. Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition? *

Yes

No

7. Do you know of any other reason why you should not do physical activity? *

Yes

No

Terms of Acceptance (Liability Waiver) *

I am voluntarily participating in the Fight For Hearts, Bootcamp and I am participating in the activity entirely at my own risk. I am aware of the risks associated with participating in this activity, which may include, but are not limited to, physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability, (including paralysis), economic or emotional loss, and death. I understand that these injuries or outcomes may arise from my own or others’ negligence, conditions related to travel, or the condition of the activity location. Nonetheless, I assume all related risks, both known or unknown to me, of my participation in this activity, including travel to, from and during this activity. In consideration of my application and permitting me to participate in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) I agree to Waive, Release and Discharge from any and all liability for my death, disability, personal injury, property damage, property theft or actions of any kind which may thereafter occur to me including my traveling to and from this event the following entity: Fight For Hearts/Syracuse Parks and Recreation and its directors, officers, employees, volunteers, representatives, and agents, the event holders, event sponsors, event volunteers, and (B) Indemnify and Hold Harmless, and Agree Not To Sue the entity mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this event, whether caused by the negligence of releases or otherwise. I hereby consent to receive medical treatment that may be deemed advisable in the event of injury, accident and/or illness during this event. I also agree that I have consulted my physician prior to beginning this exercise program and have been cleared by my physician to participate. TERMS OF ACCEPTANCE and SIGNATURE I, the [applicant] for this Liability Waiver, and PAR-Q, warrant the truthfulness of the information provided in this application.

First Name

Last Name

*

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.