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First Name
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Last Name
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Mailing Address
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City
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State
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Zip Code
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Email Address
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Cell Phone
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OK to send text messages?
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Age
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Height
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Weight
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How do you receive and view media? Check all that apply.
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Cell phone text message
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Streaming Online Video (YouTube, FaceBook, etc.)
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Email attachment (download and view content)
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Other
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What type of exercise facilities do you have access to? Check all that apply
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Fitness or Rec Center/Gym
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Outdoor or Indoor Track
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Other
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Past or current injuries? Please describe.
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What physical exercises are you engaging in?
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Release of Liability
Please read the release in its entirety
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In consideration for particpating voluntarily in the fitness and training program, the "Program", the undersigned, the "Participant", for themselves, and for their respective heirs, personal
representatives and assigns, agree as follows:
Assumption of Risk:
The undersigned hereby acknowledge and agree that they understand the nature of the Event; that Participant is qualified, in good health, and in proper physical condition to participate therein;
that there are certain inherent risks and dangers associated with the Program; and that, except as expressly set forth herein, they, knowingly and voluntarily, accept, and assume responsibility for,
each of these risks and dangers, and all other risks and dangers that could arise out of, or occur during, Participant’s participation in the Program.
Release and Waiver:
The undersigned hereby RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE Fitness & Sports Excellerated, LLC and its member
institutions, or any subdivision thereof, and each of them, their officers and employees, collectively, the “Releasees”), from and for any liability resulting from any personal injury, accident or
illness (including death), and/or property loss, however caused, arising from, or in any way related to, Participant’s participation in the Program.
Indemnification and Hold Harmless:
The undersigned also hereby agree to INDEMNIFY, DEFEND AND HOLD the Releasees HARMLESS from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities
including, but not limited to, attorney’s fees, arising from, or in any way related to, Participant’s participation in the Event, except for those arising out of the willful misconduct, gross negligence or
intentional torts of the above parties, as applicable.
Permission to Use Likeness/Name:
The undersigned further agree to allow, without compensation, Participant’s likeness and/or name to appear, and to otherwise be used, in material, regardless of media form, promoting Fitness &
Sports Excellerated, and/or its programs, events and activities, including those of its representatives and licensees.
Severability:
The undersigned expressly agree that the foregoing assumption of risk, release and waiver of liability and indemnity agreement is intended to be as broad and inclusive as is permitted by the law
of the State of Ohio and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
Acknowledgment of Understanding:
The undersigned have read this assumption of risk,release and waiver of liability and indemnity agreement, and have had the opportunity to ask questions about the same. The undersigned fully
understand this assumption of risk, release and waiver of liability and indemnity agreement, that the undersigned are giving up substantial rights in connection therewith, and that its terms are
contractual, and not a mere recital. The
undersigned acknowledge that they are signing this agreement freely and voluntarily.
The undersigned agree that clicking the agreement checkbox, typing full name into the agreement text field and selecting the agreement current date constitute their electronic signature.
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To agree to this waiver, please check the box below, type your full name into the textbox and select the date.
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I agree to the above release
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Full Name
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Date of Agreement
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Please select the preferred prepaid package
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One Month Package $200
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Four Month Package $700 (savings of $25 per month
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Six Month Package $900 (savings of $50 per month
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Preferred Payment Method
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Check / Money Order
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PayPal
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Zelle
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Other
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Promo Code
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