Waiver 2 | Lucy Hill Fitness

First Name:

Last Name:

Date of Birth:

Email:

Phone:

Address:

EMERGENCY CONTACT NAME:

EMERGENCY CONTACT NUMBER:

RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT (hereinafter the “Release Agreement”) BY SIGNING THIS DOCUMENT YOU WILL WAIVE OR GIVE UP CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE FOR NEGLIGENCE, BREACH OF CONTRACT OR CLAIM COMPENSATION FOLLOWING AN ACCIDENT

TO: LUCY HILL FITNESS and its directors, officers, employees, instructors, guides, agents, independent contractors, subcontractors, representatives, successors and assigns (all of whom are hereinafter collectively referred to as "the Releasees")

PAR-Q

Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Being more active is very safe for most people. However, some people should check with their doctor before they start becoming much more physically active.

If you are planning to become much more physically active than you are now, start by answering the seven questions in the box below. If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you start. If you are over 69 years of age, and you are not used to being very active, check with your doctor.

Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly: Check YES or NO.

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?

Yes

Do you feel pain in your chest when you do physical activity?

Yes

In the past month, have you had chest pain when you were not doing physical activity?

Yes

Do you lose your balance because of dizziness or do you ever lose consciousness?

Yes

Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity?

Yes

Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?

Yes

Do you know of any other reason why you should not do physical activity?

Yes

I confirm the information given in this form is true.

Signature of Participant (or parent/guardian if under the age of 18)

I AM AWARE OF THE RISKS, DANGERS AND HAZARDS ASSOCIATED WITH PARTICIPATING IN PHYSICAL ACTIVITIES AND I FREELY ACCEPT AND FULLY ASSUME ALL SUCH RISKS, DANGERS AND HAZARDS AND THE POSSIBILITY OF PERSONAL INJURY, DEATH, PROPERTY DAMAGE OR LOSS RESULTING THEREFROM.

RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT

I/We hereby understand and acknowledge that the training, programs, and/or events held by Lucy Hill Fitness may expose me to many inherent risks, including accidents injury, illness, or even death.

I/We assume all risk of injuries associated with participation including, but not limited to, falls, contact with other participants, the effects of the weather, including high heat and/or humidity, and all other such risks being known and appreciated by me.

I/We hereby acknowledge my responsibility in the communicating any physical and psychological concerns that might conflict with participation in activity.

I/We acknowledge that I am physically fit and mentally capable of performing the physical activity I choose to participate in.

I/We acknowledge that a no-show policy for a training session, if a session is missed or 10 minutes late for a session, the paid session will be lost. Cancellations must be made 24 hours in advance. No refunds will be granted.

After having read this waiver and knowing these facts, and in consideration of acceptance of my participation and the Lucy Hill Fitness furnishing services to me, I agree, for myself and anyone entitled to act on my behalf to HOLD HARMLESS. WAIVE AND RELEASE Lucy Hill Fitness, its officers, agents, employees, organizers, representatives, and successors from any responsibilities, liabilities, demands, or claims of any kind arising out of my participation in Lucy Hill Fitness training, programs and/or events.

By my signature, I/We indicate that I/We have read and understand this Waiver of Liability. I am aware that this is a waiver and a release of liability and I voluntarily agree to its term. I hereby authorize Lucy Hill Fitness to publish photography or video of myself. I release Lucy Hill Fitness from any reasonable expectation of privacy or confidentiality associated with any image or video of myself.

I CONFIRM THAT I HAVE READ THIS RELEASE AGREEMENT, AND I AM AWARE THAT BY SIGNING THIS RELEASE AGREEMENT I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS, ASSIGNS AND REPRESENTATIVES MAY HAVE AGAINST THE RELEASEES.

Signature of Participant (or parent/guardian if under the age of 18)

Date:

MONTH 1

WAIVER FORM

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