22.    What training fundamentals/training tools would you like to learn more about within this training cycle?    Please be as detailed as possible and prioritize, if possible.

23.  Do you have additional questions or concerns that have not been addressed within this questionnaire?

ALL CLIENTS MUST FILL OUT WAIVER & RELEASE OF LIABILITY.  Even if you filled one out last training cycle, you must fill it out again at this time.  

Run 4 Life

Waiver & Release of Liability

In consideration of the acceptance of my participation in the Run4Life Training Program (the “Training Program”), created by Run 4 Life, L.L.C., a California Limited Liability Company.  I hereby acknowledge and agree as follows:

1.  Acknowledgment.  I fully realize and acknowledge the hazardous nature and dangers of swimming, cycling, and running and participating in organized and/or private swims, rides, and runs.  I FULLY ASSUME THE RISK ASSOCIATED WITH SUCH PARTICIPATION INCLUDING by way of example, and not limitation, the following: the dangers of drowning, the danger of collision with pedestrians, vehicles, other riders, and fixed or moving objects, the dangers arising from road conditions safety hazards, equipment failure, inadequate safety equipment, THE RELEASE PARTIES’ OWN NEGLIGENCE, extreme heat and humidity, and other weather conditions, the possibility of serious physical and/or mental trauma or injury associated with the “Training Program,” and detrimental effects of pollution.

2.   Release of Claims.  I, for myself, my heirs, executors, administrators, legal representative assignees, and successors in interest (collectively “successors”) HEREBY WAIVE, RELEASE, DISCHARGE, HOLD HARMLESS, PROMISE NOT TO SUE AND INDEMNIFY Run 4 Life, L.L.C., Cheryl Kruse Shwe, its agents, contractors, representatives, volunteers, sponsors, successors (collectively “Released Parties”) and assigns the Released Parties of and from all claims, demands, damages, costs, expenses, actions, and causes of actions, whether in law or equality, in respect of death, injury, loss or damage to my person or property, howsoever caused, arising out of, by reason of, or during my attendance at or participation in the Training Program, whether as a spectator, participant, or otherwise (all of the forgoing referred to hereafter as the “Claims”), whether or not the claims result from my following any program of diet and/or exercise on the recommendation of any of the Released Parties, whether such claim arises out of events prior to, during, or subsequent to said attendance or participation, even if such claims were caused by , contributed to, or occasioned by the negligence, fault or other conduct of the Released Parties.

Anyone beginning an exercise program for the first time, or restarting an exercise program after a period of inactivity, must consult a doctor before starting the training program.

Furthermore, anyone answering “Yes” to any of the questions 1-10, a medical clearance from a physician MUST be completed prior to beginning your Training Program.

1.        Has your doctor ever said you have a heart condition?    YES   NO

2.       Do you have pains in your heart or chest?       YES   NO         

3.       Do you ever feel faint or have spells of severe dizziness?    YES   NO

4.       Do you have high blood pressure?       YES   NO

4a.  Are you taking medication for your high blood pressure?    YES   NO

5.  Do you have orthopedic or joint problems that could be aggravated by exercise?    YES   NO

6.  Are you 65 or over, and not accustomed to vigorous exercise?  YES   NO

7.  Do you have diabetes?   YES   NO

8.  Are you taking medications that might alter your response to exercise?         YES   NO

9.       Is there a physical reason why you shouldn’t follow an exercise program even if desired?   

10.  For women: Are you pregnant?    YES   NO

If you answered yes to any of the above questions, please explain below and provide medical clearance from a qualified physician.

I, , certify that this information is complete and accurate to the best of my knowledge, I have doctors approval, or will consult with one before beginning the Training Program, if the above information indicates that I should.

Please type name and date.  (Note, by typing my name, I am in effect making this a legally binding agreement.)

Please enter LOCAL emergency contact NAME and PHONE NUMBER (including cell number if applicable) and relation to you.

If LOCAL emergency contact is not next of kin, please provide next of kin emergency contact NAME(S) & PHONE NUMBER(S), regardless of city/state/country.