Health Statement

Please read and complete the health declaration carefully.

I, the undersigned, hereby declare and confirm as follows: I am the trainee/parent and/or legal guardian of the minor listed below, who will be referred to below as “the minor” and/or “the trainee”. This declaration is made in my name and the name of the minor and refers to my and the trainee’s/minor’s entry and stay in the company’s extreme sports club and to any use of the club’s facilities. As far as I know, the trainee/minor does not have any health limitation that prevents them from using the facilities in the club and/or may cause them any health and/or physical damage.

Do you feel chest pain?

  • During rest: No
  • During routine daily activities: No
  • While you are exercising: No

 

During the past year

  • Have you lost your balance due to dizziness? (Mark no if the dizziness was due only to hyperventilation) No
  • Have you lost consciousness? No

 

Has a doctor diagnosed that you suffer from asthma in the last three months for which:

  • You needed medical treatment? No
  • You suffered from shortness of breath or wheezing? No

 

Has one of your immediate family members passed away

  • From heart disease? No
  • From sudden death at an early age (before age 55 if it for a man, before age 65 if it for a woman)? No

 

Has your doctor told you in the last 5 years to exercise only under medical supervision? No

Do you suffer from a permanent (chronic) illness that is not mentioned in the questions above and may prevent or limit you from exercising? No

For pregnant women: Was this pregnancy or any previous pregnancy defined as a high-risk pregnancy? No

I confirm that I have read and understood the entire medical questionnaire above and all the answers to the questions in it as detailed above are negative and I know that if my answer to one of the questions had been positive then the trainee/minor would not have been allowed to enter the club.

I declare that I have provided full and correct information about the medical condition of the trainee/minor in the past and present and that I am not aware that the trainee/minor has any limitation that prevents them from using the facilities at the club and/or may cause them any health and/or physical damage.

I am aware that the use of the facilities and participation in activities at the club involves inherent risks that are difficult to avoid. These risks may include, but are not limited to, serious bodily harm, disability, and even death, resulting from falling, slipping, tripping, or sustaining injuries while using the club’s facilities. I acknowledge that these risks are present regardless of whether or not I follow the company’s rules and guidelines.

I understand that the use of the facilities at the club is my sole responsibility, or that of the trainee/minor if applicable. I will ensure that I am in suitable physical condition to participate in the activities and will use the facilities responsibly.

In the case of a trainee/minor participating in activities at the club, I, as the parent/legal guardian, assume full responsibility for their health and safety. I acknowledge the risks involved and hereby grant my consent for the minor to engage in the activities.

I consciously and out of free choice accept all the above-mentioned risks of injury, loss or damage that may be caused to the trainee/minor and myself due to our presence in the club and the use of its facilities and I definitively and completely waive in my name and in the name of the minor the right to sue the company for any injury and/or damage as stated above.

I have read the above regulations, we have received explanations from the company representatives regarding the safety instructions and the use of the facilities and I undertake that I and the trainee/minor will act according to them and according to the other instructions for the use of the facilities as far as such are placed in the club and/or near the facilities.

Subject to all laws, I hereby release the company, its shareholders, managers, employees and/or anyone on its behalf, from any liability for any injury, loss and/or direct and/or indirect damage, including to the body and/or property caused to the trainee/minor and/or myself in the activity in the facilities of the club or outside it for any reason whatsoever.

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