I hereby agree to release all medical information, whether immediate or past, prior to receiving any services from trainer or personal use of facilities, I understand that failure to do so will result in no liability on the part of Spearman Youth Development Center. I agree to pay operations fee at the time of agreement to services.
I have accurately stated all known physical and medical conditions. I understand the Trainer whose signature appears below and Spearman Youth Development Center are not responsible for the aggravations of conditions which were present, but not disclosed at the time of the services.
Full Name (required)
Date of Birth (required)
How did you hear about us?
Have you ever had professional training?
Do you ever have any major health problems?
Are you currently under a physician's care for any condition or have you been medically diagnosed for any condition? Explain:
How long have you had this condition?
Does this condition interfere with sleep, work or daily routine? Explain:
What are your intentions or expectations?