Health declaration

Please fill out the following form.

First name*

Last name*

Email*

Phone

Have you been hospitalized in the last 12 months?

Yes

Are you suffering from a medical condition, illness or injury?

Yes

Do you know of any medical condition, illness or injury that would prevent you from participating in this challenge today?

Yes

If you answered yes to any of the questions above, please supply additional information.

Initials*

I declare that the info I’ve provided is accurate and complete.

Please contact me to inform me of my challenge results and any musclefitgym.com news, offers and updates

I acknowledge that participating in physical exercise involves inherent risks, including but not limited to physical injury, strain, discomfort, and the possibility of serious injury or death. I assume all risks and responsibility for any injuries or other medical incidents.

I hereby release, discharge and waive all claims against musclefitgym.com, its owners, management, employees, and agents for any and all injuries, damages and/or losses that may occur while taking part in any challenge.

I consent for my image to be used for the following purposes:

In musclefitgym.com and Trainer Dan Hayward publications, on our social media channels and on our websites.

I hereby grant musclefitgym.com and Trainer Dan Hayward the absolute right to reproduce, display and disseminate worldwide and in perpetuity, in any traditional or electronic media format, my likeness as shown in the photographs/films captured at this time for the purposes given above.

I understand that if consent has been granted today for my image to be used can be removed at anytime by contacting musclefitgym.com@gmail.com

PERSONAL TRAINING - CORPORATE FITNESS - NUTRITIONAL ADVICE - WEIGHT LOSS - MUSCLE TONE - CORE STRENGTH - POSTURE CORRECTION - CARDIO FITNESS

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