212° GENERAL WAIVER Open Form 212° General Waiver Acknowledgment * I have volunteered to participate in a program of physical exercise under the direction of 212˚ Performance Gym which will include but may not be limited to weight and/or resistance training. In consideration of the agreement to instruct, assist, and train me, I do here and forever release and discharge and hereby hold harmless 212˚ Performance Gym and their representative agents, heirs, assigns, contractors, and employees from any and all claims, demands, damages, rights of action or causes of action, present or future, arising out of or connected with my participation in this or any exercise program including any injuries resulting therefrom. THIS WAIVER AND RELEASE OF LIABILITY INCLUDES, WITHOUT LIMITATION, INJURIES WHICH MAY OCCUR AS A RESULT OF (1) EQUIPMENT THAT MAY MALFUNCTION OR BREAK (2) ANY SLIP, FALL, DROPPING OF EQUIPMENT AND (3) OUR NEGLIGENT INSTRUCTION OR SUPERVISION. Assumption of Risk: I recognize that exercise might be difficult and strenuous and that there could be dangers inherent in exercise for some individuals. I acknowledge that the possibility of certain unusual physical changes during exercise does exist. These changes include abnormal blood pressure; fainting; disorders in heartbeat, heart attack; and, in rare instances, death. I understand that as a result of my participation in an exercise program, I could suffer an injury or physical disorder that could result in my becoming partially or totally disabled and incapable of performing any gainful employment or having a normal social life. I recognize that an examination by my physician must be obtained prior to involvement in this exercise program. I acknowledge and agree that I assume the risks associated with any and all activities and/or exercises in which I participate. I acknowledge and agree that no warranties or representations have been made to me regarding the results I will achieve from this program. I understand that results are individual and may vary. I ACKNOWLEDGE THAT I HAVE THOROUGHLY READ THIS WAIVER AND RELEASE AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. BY SIGNING THIS DOCUMENT, I AM WAIVING ANY RIGHTS I OR MY SUCCESSORS MIGHTT HAVE TO BRING A LEGAL ACTION OR ASSERT A CLAIM AGAINST 212˚ PERFORMANCE GYM, THEIR EMPLOYEES, AGENTS, OR CONTRACTORS FOR NEGLIGENCE. I AGREE Name * First Name Last Name Email * Phone * (###) ### #### BY TYPING YOUR NAME BELOW, YOU ARE VIRTUALLY SIGNING THIS LEGALLY BINDING DOCUMENT. * Signature First Name Last Name Date Signed * MM DD YYYY TO BE READ AND SIGNED BY THE PARENT AND/OR GUARDIAN OF A MINOR (IF APPLICABLE) I hereby state that I am the parent or guardian of the minor whose name and signature appears above. I have carefully read this agreement and fully understand its contents. I acknowledge that this release of liability is a legally binding contract between 212˚ Performance Gym and me. BY TYPING YOUR NAME BELOW, YOU ARE VIRTUALLY SIGNING THIS LEGALLY BINDING DOCUMENT. First Name Last Name Date Signed MM DD YYYY Thank you! NORMATEC COMPRESSION WAIVER Open Form Normatec Compression Therapy Liability Waiver Acknowledgement * Physical Capability Requirements Participation in a NormaTec® Compression Therapy session involves exposure to vasopneumatic compression for a short period of time. You are free to terminate the session at any time. Please read the below “Contraindications”. Contraindications NormaTec® Compression Therapy is contraindicated for patients with: · Current or unstable fractures/breaks · Recent surgery and have sutures/stitches · Open wounds, contusions, abrasions · Suspect or known Acute deep vein thrombosis (DVT) (blood clot) · Severe atherosclerosis (disease of the arteries)/Ischemic vascular disease (IVD) · Severe congestive cardiac failure (CHF) · Existing pulmonary edema (having excess fluid in the lungs) · Existing pulmonary embolism (blood clot in the lungs) · Extreme deformity of the limbs · Any local skin conditions such as gangrene, untreated or infected wounds, recent skin graft, or dermatitis · Known presence of malignancy in the legs or arms · Limb infections, including cellulitis that have not been treated · Presence of Lymphangiosarcoma (a rare cancer due to long-standing lymphedema of the upper/lower extremities) I understand that using the NormaTec® Compression Therapy may aggravate a pre-existing medical condition, or could lead to injury. I am voluntarily assuming all risks of accident or injury to me (or my child) arising out of or in any way connected with the use of the services, equipment, or facilities of 212˚ Performance Gym . I hereby release 212˚ Performance Gym and its team members, owners, personal trainers and practitioners from all liability for any damage, injury, or harm, which may be caused by, a result of, or in any way associated with participation in this service of 212˚ Performance Gym as a Guest or Member. I acknowledge that I am at least 18 years of age and otherwise legally competent to sign this release. Minors require a parent/guardian signature. I AGREE Name * First Name Last Name Date of Birth * MM DD YYYY Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### BY TYPING YOUR NAME BELOW, YOU ARE VIRTUALLY SIGNING THIS LEGALLY BINDING DOCUMENT. * Signature First Name Last Name Date Signed * MM DD YYYY TO BE READ AND SIGNED BY THE PARENT AND/OR GUARDIAN OF A MINOR (IF APPLICABLE) I hereby state that I am the parent or guardian of the minor whose name and signature appears above. I have carefully read this agreement and fully understand its contents. I acknowledge that this release of liability is a legally binding contract between 212˚ Performance Gym and me. BY TYPING YOUR NAME BELOW, YOU ARE VIRTUALLY SIGNING THIS LEGALLY BINDING DOCUMENT. First Name Last Name Date Signed MM DD YYYY Thank you!
