You have made a great decision to come to Verus and we look forward to helping you achieve your maximum health and fitness!

To reserve your training slot, please fill out the registration and health history form below. It is important that we have this information so we can serve you better. After submitting your registration, we will contact you with any questions if necessary. If you have any challenges with this form, please let us know.

Thank-you, and we look forward to meeting you soon!

General Information

Your Name (required)

Email (required)

Phone (required)

Street Address (required)

City, State (required)

Zip Code (required)

Date of Birth (required)

Emergency Name & Number (required)

Is this your first time training with Verus? (required)
YesNo

How did you hear about us? (required)

I was referred by

Fitness Level (1-10); 10 being most fit * (required)

What are your goals and expectations for joining our training program? (required)

Health & Medical History

Please Answer All Questions. If you have been with us before, please update any changes to your health status.

Has a physician ever said you have a heart condition and should only do physical activity recommended by a physician? (required)
YesNo

When you do physical activity, do you feel pain in your chest? (required)
YesNo

Are you 55 years of age or older? (required)
YesNo

Is there a history of heart disease (prior to age 55) in your immediate family? (required)
YesNo

Do you ever lose consciousness or do you lose your balance because of dizziness? (required)
YesNo

Do you have high blood pressure? (required)
YesNo

Do you have a joint or bone problem that may be made worse by a change in your physical activity? (required)
YesNo

Are you pregnant, or have you been pregnant within the last 3 months? (required)
YesNo

Have you had major or minor surgery in the last 3 months? (required)
YesNo

Have you been hospitalized in the last 2 years? (required)
YesNo

Do you have Type I or Type II diabetes? (required)
YesNo

Are you allergic to any medication (aspirin, penicillin, sulfa, etc.)? (required)
YesNo

Do you take any prescribed medications on a permanent or semi-permanent basis? (required)
YesNo

Have you ever been found to be anemic (low blood count)? (required)
YesNo

Have you ever injured your back or neck? (required)
YesNo

Do you have back pain? (required)
YesNo

Do you have any other physical conditions which cause pain (knee, hip, shoulder, etc.)? (required)
YesNo

Do you receive regular physical exams from your primary care physician? (required)
YesNo

Physician name and phone number (required)

Do you have any additional health, medical or injury conditions or history (cancer, migraine, head injury, seizure, other)? (required)
YesNo

Do you know of any other reason you should not exercise or increase your physical activity? (required)
YesNo

Approval of Health & Medical History

I certify that I understand the forgoing questions and my answers are true and complete. I also understand that if this information changes in any way in the future, it is my responsibility to notify my trainer, and that I assume the risk for any changes in my medical condition that might affect my ability to exercise.

I acknowledge that it is recommended to consult a physician prior to starting any health/fitness/nutrition program, and that only a qualified health care provider is able to diagnose and prescribe treatment for specific health conditions. If I choose not to obtain a physician's consent, I hereby agree I am doing so solely at my own risk.

I agree to the above statement (required)
YesNo

Training Agreement

We want everyone who participates in our training programs to have fun, be committed to the process, and achieve results. We want you to be so thrilled with your training experience that you will want to come back, and bring your friends and family with you.

Please checkmark the following statements:

I agree to show up for training on time every day I have signed up for unless I have notified my coach in advance or I have an excused absence from my doctor.(required)
YesNo

I understand that I may appear in images or video relating to my participation in boot camp, and give full permission to Verus Strength & Fitness to use these royalty-free in advertisements, promotions or commercials.(required)
YesNo

I understand that diet and nutrition directly affects my performance and fitness results (required)
YesNo

I further agree to bring a positive attitude, use my strengths to help others attending training, respect all other participants, embrace challenges, and most importantly, be prepared to have fun! (required)
YesNo

Waiver of Liability

Have you completed, signed and agreed to the Waiver of Liability, Indemnity Agreement and Assumption of Risk form with Verus Strength & Fitness? (required)
YesNo

Digital Signature

By typing your name into this field, you are hereby providing a digital signature.

 

Please click here after your registration is successfully submitted to reserve your spot in a class.