COVID19 digital waiver

CKO Kickboxing Miramar

7094 Miramar Rd.

San Diego, Ca 92121

First and Last Name: *Please enter your name.

Date of Birth: *

Please enter valid date.

Please fill in Address: *

Please enter address.

Phone number: *Please enter your phone number.

Email: *Please enter your email.

Gender: *Please select one here.

Emergency Contact Name: *Please enter your answer here.

Emergency Contact Phone: *Please enter your answer here.

Initial Here

I understand that gloves and shoes are required to participate in all classes. If needed, gloves can be purchased at the front desk. Unfortunately, if I come to class without shoes, I understand, that I cannot participate in class. *Please click the yellow area and provide your initials here.

Initial Here

In an effort to remain competitive in the fitness industry, CKO Miramar trainers and staff routinely take videos/pictures of a class to post on social media. I understand that I may appear in a video or image of CKO Miramar. Please click the yellow area and provide your initials here.

Initial Here

An inherent risk of COVID-19 exists in any public place where people are present. COVID-19 is an extremely contagious disease that can lead to severe illness or death. By visiting CKO Miramar, as a guest or participant, I voluntarily assume all risks related to exposure to COVID-19. I also understand, in an effort to keep fellow members and the staff at CKO Miramar safe, I will not participate or visit CKO Miramar should I show signs of a fever or flu-like symptoms. *Please click the yellow area and provide your initials here.

Initial Here

I accept full responsibility for my use of any apparatus, appliances, facility privilege, or services whatsoever owned and operated by CKO Miramar at my own risk and shall hold this club, its shareholders, directors, officers, employees, representatives, and agents harmless for any and all loss, claim, injury, or liability sustained by me resulting thereof. In addition, I acknowledge that I have received an orientation prior to taking my initial class at CKO Miramar. *Please click the yellow area and provide your initials here.

How often do you currently workout? *

N/A

Once/Week

2-3 Times/Week

4+ Times/Week

Please select at least one choice above.

What does your current exercise program consist of?

Cardio

Weight Training

Classes/Yoga/Pilates

Please select at least one choice above.

What are your personal fitness goals? *

Weight Loss

Improve Overall Health

Athletic Performance

Variety

Please select at least one choice above.

What are your fitness goals? *Please enter your answer here.

What obstacles have you faced in achieving your fitness goals in the past? *Please enter your answer here.

Do you have any exercise restrictions/injuries our instructors should know about? *Please enter your answer here.

Do you have any questions for me? Please enter your answer here.

Signature *

Click to sign

Please sign here.

Today's Date *

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The digital COVID19 waiver helps your your business.

CKO Kickboxing Miramar