Medical Questionnaire

Please fill out the following form to help us understand your needs

Are you currently suffering from a medical condition, illness, or injury?
Have you been hospitalized or concuss in the last 12 months?
Do you suffer from any of the following:

Nominated Business: BC Martial Arts

Declaration and Waiver:

  1. I realize that participation in exercise and martial arts carries some risk.  I hereby certify that I am aware of no medical conditions (except already noted herein) that may increase my risk of illness or injury due to an exercise program.  I have read and understand this questionnaire and hereby exempt, release and discharge BC Martial Arts, its servants, agents and contractors, from liability for any injury, illness or death as a result of my participation in any future program.

  2. I realize nutritional advice given is general and I should consult my GP before making any changes to my diet.

  3. I, the undersigned, in consideration of, and as a condition of, acceptance of my participation in the businesses services, for myself, my heirs, my executors and administrators, waive all and any right or cause of action which I or they might otherwise have arising out of the loss of my life, or injury and damage, or loss of any description whatsoever which I may suffer.

  4. This waiver release and discharge shall operate separately in favour of all persons, corporations and bodies involved or otherwise engaged in the operation of BC Martial Arts, or servants or representatives of them.

Thanks for submitting!