Beruflich Dokumente
Kultur Dokumente
2
The
Werezoo
Training
Pack
Initiation
Participants
Name:____________________________________
Participants
Signature:_______________________________
Date:_________________________
Parent/Guardian
Signature:__________________________
Date:_________________________
Witness
Signature:____________________________________
Date:_________________________
Street
Address:__________________________________________________________________________
Shirt
Size:
Mens
___________
Womens_____________
Informed
Consent
Form
During
the
Werezoo
Training
Program,
various
systems
will
be
tested
such
as
cardiorespiratory
endurance,
muscular
strength/endurance,
balance
and
flexibility.
Most
of
the
tests
and
workouts
focus
on
the
cardiorespiratory
endurance
and
muscular
endurance
systems.
When
testing
both
of
these
systems,
an
inherent
risk
comes
with
it.
Depending
on
the
program
you
sign
up
for,
any
distances
from
50
meters
to
75
miles
will
be
run
on
both
smooth
and
rough
surfaces.
Muscular
fatigue
may
occur
after
or
during
workouts.
While
there
will
be
instruction
of
proper
pre
and
post
workout
stretching,
warm-up,
and
cool
down
provided
for
the
athletes,
any
misuse
or
non-use
of
necessary
procedures
or
food/beverage
will
be
solely
the
responsibility
of
the
athlete.
In
signing
this
consent
form,
you
acknowledge
that
you
have
read
and
understood
the
description
of
these
workouts
and
their
complications/risks.
In
addition,
you
state
that
any
questions
you
have
about
the
workout
plan
have
been
answered
and
that
you
have
also
made
the
trainers
and
Werezoo
aware
of
any
physical
impairments
you
may
or
may
not
have.
Participants
name:________________________________________
Participants
Signature:___________________________________
Date:__________________
Parent/Guardians
Signature:____________________________
Date:__________________
Witness
Signature:________________________________________
Date:__________________
3
Release/Assumption
of
Risk
Agreement
In
consideration
of
gaining
access
to
participate
in
the
workouts
associated
with
the
Werezoo
Training
Pack,
I
do
hereby
waive,
release,
and
forever
discharge
The
Werezoo
and
its
officers,
agents,
employees,
representatives,
executors,
and
all
others
from
any
and
all
responsibilities
or
liability
for
injuries
or
damages
resulting
from
my
participation
in
any
activities
in
said
program__________________
(Please
Initial)
I
understand
the
policies
and
procedures
set
forth
by
The
Werezoo
and
I
have
had
the
opportunity
to
discuss
my
specific
needs
in
relation
to
participatory
activity,
and,
as
a
result,
I
do
voluntarily
request
the
right
to
participate
in
this
program
of
exercise.
____________________
(Please
Initial)
Also,
in
consideration
of
the
above
factors,
I
acknowledge
the
existence
of
risks
in
connection
with
these
activities,
assume
such
risks,
and
agree
to
accept
the
full
responsibility
for
any
and
all
injuries
sustained
by
my
participation
in
the
course
and
scope
via
the
use
of
the
facilities
and/or
its
equipment.
Most
specifically,
I
acknowledge
and
accept
responsibility
for
injuries
arising
out
of
those
activities
that
involve
risk
in
any
of
the
following
areas:
The
Use
of
facility
equipment
Participation
on
group
activities
related
to
exercise
and
activity
Incidents
that
occur
within
the
instructional
facility
and
on
any
outside
public
and/or
private
surfaces.
In
addition,
it
was
seriously
recommended
that
I
consult
with
a
physician
before
engaging
in
any
activities
associated
with
The
Werezoo.
_______________
(Please
Initial)
Any
and
all
conditions
must
be
submitted
in
writing
prior
to
the
first
workout.
If
the
athlete
learns/becomes
aware
of
any
medical
condition(s)
during
the
course
of
a
season,
it
is
the
sole
responsibility
of
said
athlete
to
bring
written
documentation
of
the
condition(s)
prior
to
the
commencement
of
the
next
session.
________(Please
Initial)
Having
read
the
preceding,
I
acknowledge
full
understanding
of
those
risks
set
forth
herein
and
knowingly
agree
to
accept
full
responsibility
for
my
own
exposures
to
such
risks
and
to
waive
full
responsibility
and
liability
on
behalf
of
Werezoo
Training.______________
(Please
Initial)
Participants
Name:________________________________
Participants
Signature:___________________________
Date:____________
Parent/Guardian
Signature:______________________
Date:____________
Witness
Signature:_______________________________
Date:____________
4
Health/Medical
Questionnaire
Date:_____________________
Name:_______________________
D.O.B:________________
Last
4
Digits
of
Soc.Sec#_________
Address:___________________________________________________________________________________
Phone
(H)_____________________
(M)____________________________
Email
address:________________________________________________
Emergency
Contact:
Name:_______________________________________
Relationship:________________________________
Phone
(H)_____________________
(M)_____________________________
Personal
Physician
Name:__________________________
Phone:______________________________
Fax:__________________
Preferred
Hospital:_________________________________________________________________________
Insurance
Co:_______________________________________________________________________________
Present/Past
History
Have
you
had
or
do
you
currently
have
any
of
the
following
conditions?
(Check
if
yes.)
______
Rheumatic
Fever
______
Recent
operation
______
Edema
______
High
Blood
Pressure
______
Injury
to
back
or
knees
______
Low
blood
pressure
______
Seizures
______Lung
Disease
______
Heart
Attack
______
Fainting
of
Dizziness
______Diabetes
______
High
Cholesterol
______
Orthopnea
______
Shortness
of
breath
______
Chest
Pains
______
Palpitations
or
tachycardia
6
12. Do
you
have
injuries
(bone
or
muscle
disabilities)
that
may
interfere
with
exercising?
Yes_____
No_____
13. Do
you
smoke?
Yes______
No______
If
yes,
how
much
per
day
and
what
was
your
age
when
you
started?_________________________________________________________
14. What
is
your
body
weight
now?_________
What
was
it
one
year
ago?__________
At
age
21?_________
15. Do
you
follow
or
recently
followed
any
specific
dietary
intake
plan,
and
in
general
how
do
you
feel
about
your
nutritional
habits?
_________________________________________________________________________________________
_________________________________________________________________________________________
16. List
the
medications
you
are
presently
taking
_________________________________________________________________________________________
_________________________________________________________________________________________
17. List
in
order
your
personal
health
and
fitness
objectives
a. ________________________________________________________________________________
b. ________________________________________________________________________________
c. ________________________________________________________________________________
Press
Release
Form
I,__________________________________________
acknowledge
that
during
any
and/or
all
meetings/workouts
with
The
Werezoo
and/or
with
The
Werezoo
affiliated
meetings,
there
may/will
be
the
use
of
camera/video
camera/audio
recording.
I
accept
that
if
I
am
recorded
on
any
of
the
aforementioned,
that
I
hereby
allow
The
Werezoo
to
use
my
image
and/or
sounds
in
any
form
of
media
that
includes
but
is
not
limited
to
The
Werezoos
webiste
(www.werezoo.com),
flyers,
audio/visual
commercials
and
any
other
promotional
or
for
profit
articles
without
the
necessary
implication
of
compensation.
(Initial)____________