Waiver of Limited Liability / Informed Consent

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

This agreement is between Dawn Richiell, zClub Fitness, LLC dba 63 Steps to Health / Cat Eyed Fitness, additional instructors and any individual(s) who may be participating in fitness classes and / or instruction at zClub Fitness, located at 100 Factory Street, Nashua, NH 03060.

Email *

Full Name *

Emergency Contact Name & Number *

How did you hear about us?

I, hereby agree to the following: (please check all boxes) *

I am participating in fitness classes offered by a licensed instructor. I recognize that all fitness classes require physical exertion that may be strenuous and may cause physical injury, including death, and I am fully aware of the risks and hazards involved.

I understand that it is my responsibility to consult with a physician prior to and regarding my participation in fitness classes. I represent and warrant that I am physically fit and I have no medical condition that would prevent my full participation in fitness classes.

I understand and accept any risk of transmitting and/or contracting Covid-19 or any other virus/disease. Said risk shall be borne solely by the participant in fitness classes.

In consideration of being permitted to participate in fitness classes, I agree to assume full responsibility for any risks, injuries, or damages (known or unknown), property damage or loss of any kind, including those related to Covid-19, in which, I may incur as a result of participation in fitness classes.

In further consideration of being permitted to participate in fitness classes, I knowingly, voluntarily and expressly waive any claim I may have against the authorized instructor(s) for any injuries of damages (known or unknown), property damage and loss of any kind, including death or contracting Covid-19 that I may sustain as a result of participating in any fitness classes.

This is a legally binding release, Waiver, Discharge and Covenant Not to Sue (collectively "Release") zClub Fitness or any of its authorized Instructors) for any injury, death, property damage or loss of any kind caused by my voluntary participation in any fitness class. Authorized instructors include Dawn Richiell and any additional instructors taking part in zClub Fitness dba 63 Steps to Health fitness programs. This Release, Waiver, Discharge and Covenant Not to Sue is made voluntarily by me, the undersigned Releasor, on my own behalf, and on behalf of my heirs, executors, administrators and legal representatives.

I hereby grant permission to use my likeness in a photograph in any and all of its publications, including website and social media entries, without payment or other consideration. I understand and agree that these materials will become the property of zClub Fitnessm LLC dba 63 Steps to Health / Cat Eyed Fitness and will not be returned. I hereby irrevocably authorize zClub Fitness LLC, dba 63 Steps to Health / Cat-Eyed Fitness to edit, alter, copy, exhibit, publish, or distribute this photo or video for purposes of publicizing fitness programs or for any other lawful purpose. in addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph or video. I hereby old harmless and release and forever discharge zClub Fitness LLC dba 63 Steps to Health / Cat Eyed Fitness from all claims, demands and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

Required

Clear form

Never submit passwords through Google Forms.

This form was created inside of zClub Fitness. Report Abuse

Forms