WELCOME TO THE 12-HOUR TREAD-A-THON

Before you begin, please complete the form below:

First Name *

Last Name *

Phone *

Email *

Do you have any pre-existing health conditions that may impact your participation in this event? *

Yes

If yes. Please provide more information about your pre existing health conditions.

Do you have any pre existing or current injuries that may affect your participation in this event? *

Yes

If yes. Please provide more information about your pre existing or current injuries

If applicable, are you clear to exercise from your injuries or from returning to exercise post-partum? *

Yes

N/A

I agree to the terms and conditions of The Gym Tumut. By participating in the workouts, I hereby assume the risks of any injuries that I may sustain on the premises. I hereby remise, release and forever discharge your facility from any liability, responsibility or actions suits, damages claims or judgements that may results from any personal injury or even death I may sustain while on the premise, as a result of my participation. *

I Agree

Guardian Name (If participants under age of 18)

Signature Panel *

Clear