We are thankful and excited that you are taking the first step to explore Muay Thai. Please read and digitally sign this waiver before coming to your first class.


CHONBURI MUAY THAI INFORMED CONSENT FORM
Please fill out all the information requested below


I give my consent to participate in the exercise and Muay Thai program conducted by Chonburi Muay Thai.

Benefits

Participation in a regular program of physical activity has been shown to produce positive changes in a number of organ systems.  These changes include increased work capacity, improved cardiovascular efficiency, and increased muscular strength, flexibility, power and endurance.

Risks

I recognize that exercise carries some risk to the musculoskeletal system (sprains, strains) and the cardio-respiratory system (dizziness, discomfort in breathing, heart attack).  I hereby certify that I know of no medical problem (except those noted below) that would increase my risk of illness and injury as a result of participation in a regular exercise and Muay Thai program.

Testing and Results

I understand that I will undergo initial testing and intro class to determine my current physical fitness status.  The testing will consist of completing a health history questionnaire.

I further understand that such screening is intended to provide Chonburi Muay Thai with essential information used in the development of individual Muay Thai programs. I understand that my individual results will be made available only to me. I also understand that the testing is not intended to replace any other medical test of the service of my physician. I may share the results with whomever I please, including my personal physician. By signing this consent form I understand that I am personally responsible for my actions during my tenure with Chonburi Muay Thai and that I waive the responsibility of Chonburi Muay Thai if I should incur any injury as a result of my negligence.

Please check any that apply:
Name
Name
Sign