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Elementor #12913
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Participant Information
Participant's Name
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Participant's Date of Birth
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Participant Activity Name
Participant's Email
*
Participant's Phone
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Activity or Event Details
Activity or Event Name
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Date of Activity or Event
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Authorizations
Release of Liability
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I hereby certify that I do not have any health issues that would be affected by participation in physical training, and in the event that I do have any such health issue and/or condition I shall immediately notify the staff at ADAPT prior to engaging in the physical activity. Participants involved in any activities offered by ADAPT may be photographed or videotaped during training. The undersigned hereby consents to the use of these photographs and/or videos without compensation, on the ADAPT website or in any editorial, promotional or advertising material produced and/or published by ADAPT. I, the undersigned, am aware that there are significant risks involved in all aspects of physical training. These risks include, but are not limited to: falls which can result in serious injury or death; injury or death due to negligence on the part of myself, my training partner, or other people around me; injury or death due to improper use or failure of equipment; strains and sprains. I am aware that any of these above mentioned risks may result in serious injury or death to myself and or my partner(s). I willingly assume full responsibility for the risks that I am exposing myself to and accept full responsibility for any injury or death that may result from participation in any activity or class while at, or under direction of ADAPT. In consideration of the above mentioned risks and hazards and in consideration of the fact that I am willingly and voluntarily participating in the activities offered by ADAPT, I, the undersigned hereby release ADAPT, their principals, agents, employees, and volunteers from any and all liability, claims, demands, actions or rights of action, which are related to, arise out of, or are in any way connected with my participation in this activity, including those allegedly attributed to the negligent acts or omissions of the above mentioned parties. This agreement shall be binding upon me, my successors, representatives, heirs, executors, assigns, or transferees. If any portion of this agreement is held invalid, I agree that the remainder of the agreement shall remain in full legal force and effect. If I am signing on behalf of a minor child, I also give full permission for any person connected with ADAPT to administer first aid deemed necessary, and in case of serious illness or injury, I give permission to call for medical and or surgical care for the child and to transport the child to a medical facility deemed necessary for the well being of the child. The participant recognizes that there is risk involved in the types of activities offered by ADAPT. Therefore the participant accepts financial responsibility for any injury that the participant may cause either to him/herself or to any other participant due to his/her negligence. Should the above mentioned parties, or anyone acting on their behalf, be required to incur attorney’s fees and costs to enforce this agreement, I agree to reimburse them for such fees and costs. I further agree to indemnify and hold harmless ADAPT, their principals, agents, employees, and volunteers from liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in activities offered by ADAPT, at the main building or abroad. This includes but is not limited to parks, recreational areas, playgrounds, areas adjacent to main building, and/or any area selected for training by ADAPT. I have read and understood the foregoing assumption of risk, and release of liability and I understand that by signing it obligates me to indemnify the parties named for any liability for injury or death of any person and damage to property caused by my negligent or intentional act or omission. I understand that by signing this form I am waiving valuable legal rights. COVID-19 WAIVER AND RELEASE OF LIABILITY Acceptance of Risk. By signing this agreement, I acknowledge the contagious nature of the novel coronavirus (“COVID-19”) and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by my use of the exercise equipment and facilities provided by ADAPT and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, ADAPT employees, other facility members, and their families. Rules. I agree to comply with the Center of Disease Control (CDC), local health district, and ADAPT’s guidelines and policies including, but not limited to, the use of surgical masks or improvised masks such as scarves, bandanas, and handkerchiefs, to reduce the risk of exposure to myself or others; I agree to wash or sanitize my hands after using the restroom, sneezing, and coughing; I will properly wear and utilize sterile gloves; I agree to wipe all equipment that I come in contact with at ADAPT; I agree to inform ADAPT if I exhibit symptoms associated with COVID-19 or come in contact with a person diagnosed with or exhibiting symptoms. Liability Release: I agree to waive, discharge, and covenant not to sue ADAPT, their respective owners, officers, directors, employees, or agents (the “Released Parties”) and each of them from any and all claims for sickness, injuries, damages, or loss that I or my family may experience to my use of the exercise equipment and facilities provided by ADAPT. Indemnification: I agree to indemnify and defend the Released Parties from and against all claims, causes of action, damages, judgement, costs and expenses, including attorneys’ fees and other litigation costs which may arise due to my use of the exercise equipment and facilities provided by ADAPT.
Participant's Signature
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Clear Signature
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