Health Waiver | Unbroken Fitness

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Health Questionnaire/Waiver

Client First name*

Client Last name*

Email*

Phone*

Birthday*

Month

Day

Year

How did you hear about us?

I'm a parent of a participating minor

Parent's First Name

Parent's Last Name

Has a doctor ever said you have a heart condition and recommended only medically supervised activity?*

Yes

Do you have chest pain brought on by physical activity?*

Yes

Do you have a bone or joint problem that could be aggravated by physical activity?*

Yes

Do you tend to lose consciousness or fall over as a result of dizziness?*

Yes

Are you aware, through your own experiences or a doctors advice, of any other physical reason against your exercising without medical supervision?*

Yes

Are you over the age of 65 and not accustomed to vigorous exercise?*

Yes

If you answered yes to any of the above, please answer the following:

Have you consulted your physician regarding increasing your physical activity and/or starting a personal training program?*

Yes

Not Applicable

If you answered NO to the previous question, will you consult your physician prior to increasing your physical activity and/or starting a personal training program?*

Yes

Not Applicable

Please indicate yes/no for the below medical conditions:

Heart Condition:*

Yes

Diabetes:*

Yes

Asthma (uncontrolled):*

Yes

Short of Breath:*

Yes

Arthritis/Bursitis:*

Yes

Rheumatism:*

Yes

Hernia:*

Yes

Recent Surgery (past 6 months):*

Yes

Sacroiliac Problems:*

Yes

Angina:*

Yes

High Blood Pressure:*

Yes

Knee Problems:*

Yes

Back Problems (mark all that apply):*

Lumbar

Thoracic

Cervical

None

I certify that the above statements are true and correct. I understand that a Doctor's note may be requested. If a note is requested, I should not proceed with this workout until the note is received.

Signature of Participant/Parent or Legal Guardian*

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Unbroken Fitness Solutions LLC – General Liability Waiver & Informed Consent

1. Acknowledgment of Services

I, the undersigned, understand that I am voluntarily participating in one or more services provided by Unbroken Fitness Solutions LLC (“Company”), including but not limited to:

Personal training (in-person or virtual)
Group fitness classes
24/7 gym facility use
Mobile application programs
Wellness services (e.g., infrared sauna, stretching, myofascial release, recovery sessions)
Any related events, workshops, or activities, whether on or off company premises

2. Assumption of Risk

I acknowledge that participation in physical exercise, wellness treatments, and related activities involves inherent risks, including but not limited to:

Muscle soreness, strains, sprains, or injury
Risk of falls or accidents from use of equipment or facilities
Cardiovascular events (e.g., heart attack, stroke)
Dehydration or heat-related illness (including sauna use)
Worsening of pre-existing medical conditions

I understand these risks may be foreseeable or unforeseeable and may result from my actions, the actions of others, or the condition of the facilities and equipment.

I voluntarily assume full responsibility for any injury, illness, damage, or loss I may sustain.

3. Medical Clearance & Disclosure

I affirm that:

I have completed the Company’s medical questionnaire honestly and to the best of my knowledge.
I will inform the Company of any changes to my health, injury status, or medication use.
I have either received medical clearance from my physician or have chosen to participate at my own risk.
I understand that Company staff are not medical professionals and cannot diagnose or treat medical conditions.

4. Release of Liability

To the fullest extent permitted by law, I release and discharge Unbroken Fitness Solutions LLC, its owners, officers, employees, contractors, and affiliates from any and all claims, demands, or causes of action arising from my participation in any Company service or activity, whether caused by negligence or otherwise.

This release applies to all legal theories, including negligence, premises liability, and breach of any duty of care.

5. Indemnification

I agree to indemnify and hold harmless the Company from any claims, damages, or expenses (including attorney’s fees) arising out of my actions or failure to follow instructions while using Company services.

6. Minors

If the participant is under 18, a parent or legal guardian must sign this waiver, assuming all responsibility and agreeing to all terms on the minor’s behalf.

7. Severability

If any provision of this waiver is found to be unenforceable, the remaining provisions shall remain in effect.

8. Acknowledgment

I have read and fully understand this waiver, and I voluntarily agree to its terms. I understand that by signing this document, I am giving up substantial legal rights, including the right to sue.

I agree to the above terms.

services@unbrokensd.com

(858) 221-6406

11605 Duenda Rd. Suite B.

San Diego CA. 92127

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