Between The Bumpers — Waiver & PAR-Q

Participant Information

Tell us who's training with us.

First Name *

Required

Last Name *

Required

Date of Birth *

Required

Best Email *

Enter a valid email

Mobile Phone *

Required

Home Phone (optional)

Full Address *

Required

Your Information (Parent, Guardian, or Caregiver)

The person completing and signing this form on the participant's behalf.

Your First Name *

Required

Your Last Name *

Required

Relationship to Participant *

Required

Your Phone *

Required

Your Visit

Help us know what brings you in so the right coach is ready for you.

What brings you to BTB? *

Required

Referred by / coming with (optional)

How did you hear about us? (optional)

Planned first visit (optional) Not sure yet (TBD)

Emergency Contact

Who should we call in an emergency?

Emergency Contact Name *

Required

Emergency Contact Phone *

Required

Physical Activity Readiness (PAR-Q)

Regular physical activity is safe for most people. These questions tell us whether it's worth checking with a doctor or qualified exercise professional before becoming more active. Please answer every question honestly.

Allergies

Special Needs / Considerations

Current Medications

9If you answered YES to any question above, do you consent to obtaining medical clearance before exercising?

Yes No N/A

If you answered YES to one or more questions, we ask that you consult your physician before starting. Tell them which questions you answered YES to, then follow their advice on suitable activity.

Agreements & Consent

Please read each section and confirm your agreement.

I have read and agree to the Waiver, Release of Liability, and assumption of risk above. *

I understand the studio guidelines and session courtesy above. *

I grant Between The Bumpers permission to use photos / video for promotion as described. (optional)

I confirm the information above is accurate and that the participant is in good health and able to participate. I will inform Between The Bumpers of any new medical conditions or injuries. *

Signature

Sign in the box below using your finger, stylus, or mouse.

✕

Please add your signature.

Type your full name to confirm *

Required

Date *

Required

On submit, a signed PDF is generated for our records. If email delivery is configured, a copy is sent to the studio automatically. You'll also be given a PDF copy for your own files.

Waiver, Release & Physical Activity Readiness