Iron Arena bench Press Questionnaire

The purpose of this questionnaire is for you to inform me of your past and current physical state as well as your training history.  Please answer the following questions concisely, completely, and truthfully. 

Name *
Phone *
Address *
Do you currently have any illness or infection of any kind that might inhibit your ability to train? *
Do you currently take any medications that might inhibit your ability to train? *
Have you ever sustained any major injuries? *
(Arthritis, Bursitis, Tendinitis, shoulder, knee, hip, or lower back pain, etc?)
Training-Specific Questions
If not applicable, put "n/a"
Specify type of gear worn (belt, knee sleeves, wrist wraps, no belt?) If not applicable, put "n/a"
If not applicable, put "n/a"
Agreement and release of Liability
Please read the waiver below *
In consideration of being allowed to participate in the activities and programs offered by Iron Arena LLC., and to use its programs and training, in addition to the payment of any fee or charge, I do hereby waive, release and forever discharge and hold harmless Iron Arena LLC. from any and all responsibility, liability, cost and expenses, including injuries or damages, resulting from my participation in any activities, or my use of any programs designed by Iron Arena LLC. I do also hereby release Iron Arena LLC. from any responsibility or liability for any injury or damage to myself, or in any way arising out of or connected with my participation in any activities with Iron Arena Powerlifting & Performance or the use of any equipment of Iron Arena Powerlifting & Performance. In addition, All individualized programs are for the use of the customers of Iron Arena and are not to be resold on the internet or used to coach other individuals. The programs are not to be posted online and are the intellectual property of the owner of Iron Arena.