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Round 1 Waiver

Have you suffered from any of the following conditions?*
Heart Murmur Chest Pains or Palpitations
High Blood Cholesterol
Stroke
Cancer
Asthma or Respiratory Illness
Neck or back pain
Epilepsy
Fainting or Dizziness
None of the above
Have you had any major operations or bone fractures?*
Yes
No
Are you taking any of the following medications?*
Diuretics
Insulin
Epilepsy Medication
Beta Blocker
Ace Inhibitors
Diabetic Pills
None of the above
Are you pregnant?*
Yes
No
Are there any other reasons you're aware of which might prevent you from exercising safely?*
Yes
No
I acknowledge that I am participating in intense physical exercise at my own risk. I understand that before commencing an activity which involves physical exercise, ROUND 1 recommends that I should consult my doctor to ensure the activity is suitable for me. I agree to inform ROUND 1 regarding any and all the relevant information about my physical condition and of any recommendations by my doctor, and that I will keep information updated. I acknowledge that ROUND 1 accepts no liability for injury other than in respect of injury resulting from the negligence of, or failure of care by ROUND 1 and it's employees or coaches during the term of their employment. I acknowledge that ROUND 1 accepts no liability for damages or loss to personal property.
I acknowledge*

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