Omni Wellness & Performance 'Sports Performance Training' Waiver & Enrollment

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Sports Performance Training: Summer/Fall Training
Where: 9860 Fairfax Blvd, Fairfax, Va 22030
Payment: Invoicing and Credit Card on File via Square or Venmo

Email *

Parents Name *

Child's Name *

Phone *

I want to register my student athlete pay as you go month to month for Sport Performance $255/month *

Yes

Required

I want to register my student athlete in a 6 month membership for Sport Performance $225/month

Yes

I want to register my student athlete in a 12 month membership for Sport Performance $220/month

Yes

Clear selection

SECTION 2 – AGREEMENT (1) FOR ACKNOWLEDGMENT OF RISK, (2) FOR WAIVER, DISCLAIMER, AND RELEASE OF LIABILITY; (3) NOT TO SUE, AND (4) FOR INDEMNITY. I, on behalf of myself and on behalf of my heirs, personal representatives, spouse, next of kin, successors and assigns, hereby understand, acknowledge, and voluntarily agree with Omni Wellness and Performance, their officers, directors, employees, agents, contractors, insurers and/or landlords, property owners where physical training may occur and each of their successors and assigns (hereinafter collectively the “Company”) as follows:I HAVE VOLUNTARILY DECIDED TO TAKE ADVANTAGE OF THE PHYSICAL TRAINING PROVIDED BY BE Omni Wellness and Performance. I KNOW THAT PHYSICAL TRAINING CAN BE A HAZARDOUS AND DANGEROUS ACTIVITY AND INVOLVES BOTH INHERENT AND EXTRINSIC, AND BOTH NATURAL AND ARTIFICIAL RISKS THAT MAY RESULT IN ALL MANNER OF HARM, PROPERTY DAMAGE, SERIOUS PERSONAL INJURIES, OR DEATH TO ME AND/OR OTHERS FROM, FOR EXAMPLE: (a) FALLS, (b) OBJECTS FALLING ONTO ME OR OTHERS, (c) IMPROPER USE, INSTALLATION OR MAINTENANCE OF GEAR, EQUIPMENT AND/OR APPARATUSES, (e) GEAR AND EQUIPMENT DEFECTS OR MALFUNCTION, (f) FAILURE TO FOLLOW PROPER TRAINING PROCEDURES, (g) IMPROPER OR INSUFFICIENT TRAINING, SUPERVISION, AND/OR INSTRUCTION (h) ROPE ABRASION OR ENTANGLEMENT, (i) CUTS AND ABRASIONS RESULTING FROM SKIN CONTACT WITH EQUIPMENT, (j) FAILURE OF ROPES, SLINGS, BOLTS, CHAINS, OR ANY PART OF THE TRAINING EQUIPMENT. These descriptions are not all of the risks associated with the physical training to be provided to me, and the above list in no way limits the scope of this Agreement. *

Parent initials

I use the physical training equipment, gym(s), and any other facility or location where the physical training occurs “as is,” WITHOUT ANY warranties which extend beyond the description on the face thereof, WITHOUT ANY warranty of merchantability, and use them at MY OWN RISK *

Parent initials

Other:

I FOREVER WAIVE, RELEASE AND DISCHARGE THE COMPANY FROM ANY AND ALL LIABILITIES, CLAIMS, DEMANDS, OR CAUSES OF ACTION WHATSOEVER FOR ANY HARM, LOSS, DAMAGE, PROPERTY DAMAGE, PERSONAL INJURIES OR DEATH DUE TO ANY NEGLIGENCE, OR ANY OTHER CAUSE (INCLUDING, BUT NOT LIMITED TO THE NEGLIGENCE OF THE COMPANY, OR ITS EMPLOYEES, AGENTS, OR CONTRACTORS, OR OTHERWISE) RESULTING FROM, ARISING OUT OF, OR IN CONNECTION WITH MY PHYSICAL TRAINING WITH THE COMPANY WHEREEVER SAID PHYSICAL TRAINING MAY OCCUR. *

Parent initials

If any term or provision hereof is invalid, illegal or unenforceable, the invalid, illegal or unenforceable term or provision shall be stricken only to the minimal extent necessary, and the remaining terms and provisions hereof shall remain unimpaired. No provision hereof can be waived or changed in any way (notwithstanding any purported change on this form) except expressly in writing signed by an officer of the Company. All terms and paragraphs apply even if not initialed. This Agreement has no expiration date. *

Parent initials

Section 3 Media Release Form: I, grant permission to Omni Wellness and Performance, herein after known as the “Media” to use my child (photographs and/or video) for use in Media publications. I hereby waive any right to inspect or approve the finished photographs, videos or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the image. *

Parent Initials YES

I, agree to the following: I understand the above symptoms and affirm that I, as well as all household members, do not currently have, nor have experienced the symptoms listed above within the last 14 days. I affirm that I, as well as all household members, have not been diagnosed with COVID- 19 within the last 30 days. I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 within the last 30 days. I affirm that I, as well as all household members, have not traveled outside of the country, or to any city outside of our own that is or has been considered a “hot spot” for COVID-19 infections within the last 30 days. I understand that this business and my massage therapist cannot be held liable for any exposure to the virus or any other contagion caused by misinformation on this form or the health history provided by each client. By signing below I agree to each above statement and release the massage therapist and business from any and all liability for the unintentional exposure or harm due to COVID-19. Your massage therapist and all employees of this facility agree that they abide by these same standards and affirm the same. We also affirm that we have improved and expanded our sanitization protocols to more thoroughly fight the spread of COVID-19 and other communicable conditions. *

I Agree

I disagree

I HAVE READ, UNDERSTAND AND AGREE TO EACH AND EVERY TERM, AND AM VOLUNTARILY SIGNING THIS AGREEMENT. *

E-Signature

Date Signed *

YYYY

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of Stretch Moves. Report Abuse

Forms