SIGN UP FORM Step 1 of 2 50% Full Name* First Last NicknameContact No.*Present AddressBirthdate* Facebook NameInstagram NameGoals in joining the Strive Fitness family (you may check maximum of 3 goals):* Weight Loss Relieve Stress Gain more Muscle Train for Competition Improve Physical Health Cross Training for other Sports Others, pls indicate:Please list any medical conditions or physical limitations that we need to be aware of (examples: heart problems, hypertension, diabetes, asthma, injuries, etc.)*In Case of EmergencyContact Person*Contact no.* Liability Waiver (Please read carefully before signing below.)Date I agree, being aware of my own health and physical condition, and having knowledge that my participation in any exercise program may be injurious to my health, I am voluntarily participating in physical activity with STRIVE FITNESS. Having such knowledge, I hereby release STRIVE FITNESS, their representatives, agents, and successors from liability for accidental injury or illness, which I may incur as a result of participating in the said physical activity. I hereby assume all risks connected therewith and consent to participate in the said program. I agree to disclose any physical limitations, disabilities, ailments, or impairments that may affect my ability to participate in said fitness program. This iframe contains the logic required to handle Ajax powered Gravity Forms.