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CASUAL VISIT REGISTRATION FORM

Full Name*
Date of Birth*
Date Format: MM slash DD slash YYYY
Email*
Enter Email Confirm Email
Emergency Contact Mobile Number*
Gender*
- Female
- Male
- Non-Binary
What type of training do you currently do? (e.g. running, yoga, weights etc)*
From 1-10, how would you rate your current activity level (1 being not active at all, 10 being extremely active)*
What is Your main reason for wanting to attend Empire?*
Do You currently have any injuries or medical conditions Your Empire Coaches need to be aware of?*
- Yes
- No
If Yes, please provide details:*
Participation & Indemnity*
- I Agree
I warrant to The Empire Bodyshop that all information I have provided on this form is of a true and correct nature. I accept that I will not have any claim of any nature against The Empire Bodyshop for any illness, injury or adverse change in medical condition or state of health arising directly or indirectly from any program or advice provided by or carried out preparatory to or as part of any program I undertake whilst under the supervision or instruction of The Empire Bodyshop. Any rights granted to me by law which are not capable of change by agreement remained unaffected by the terms of this agreement. Any injury I may incur will be reported to a member of The Empire Bodyshop Team immediately for escalation to the Lead Coach so a determination can be made as to my ability to complete the bootcamp or not and I agree to adhere to the Trainers decision in this matter. I consent to the release and publishing of my image or video footage containing my participation with The Empire Bodyshop’s Coaches & Crew on public domains including social media, newsletter publications, website and email communications.
Date
Date Format: MM slash DD slash YYYY

September 16, 2022/by Emma

KEEPING IT CASUAL HUH?

CASUAL VISIT REGISTRATION FORM

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