Gym Health Waiver

To register to our gym please fill out the following medical form

First Name

Email Address

Last Name

Date of Birth

Do you have a doctor’s permit to participate in intense physical activities?

No

Yes

Have you lost your consciousness in the last past 12 months?

No

Yes

Initials

Today's Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

Thrivo Technologies

2025 Washington Avenue

Philadelphia, PA 19146

Tel: 551-580-4212

Enter Your Name

Enter Your Email

Your Phone

Salon Name

Location

Enter Your Message

Thanks for submitting!