Loading...

 

 

WAIVER: THE MEMBER(S)/ guests ACKNOWLEDGES AND ACCEPTS THE RISKS INHERENT IN THE USE OF THE RUSHVILLE FITNESS AND COMMUNITY CENTER’S SERVICES AND FACILITIES. THE MEMBER(S)/ Guests HEREBY VOLUNTARILY ASSUMES THE RISK OF INJURY, ACCIDENT, DEATH, LOSS, COST, OR DAMAGE TO HIS OR HER PERSON OR PROPERTY WHICH MIGHT ARISE FROM THE USE OF RUSHVILLE FITNESS AND COMMUNITY CENTER’S SERVICES OR FACILITIES. THE MEMBER(S)/ Guests, HIS OR HER HEIRS, EXECUTORS, REPRESENTATIVE, OR ASSIGNS, HEREBY RELEASE THE RUSHVILLE FITNESS AND COMMUNITY CENTER FROM ALL CLAIMS OR LIABILITIES FOR PERSONAL INJURY OR PROPERTY DAMAGE OF ANY KIND SUSTAINED BY THE MEMBER WHILE ON THE PREMISES OF THE RUSHVILLE FITNESS AND COMMUNITY CENTER. BINDING CONTRACT: This agreement represents the complete understanding between the member(s)/guests  and the Rushville Fitness and Community Center unless modified in writing by the parties. No representations, written or oral, other than those contained within this agreement are authorized by or binding upon the Rushville Fitness and Community Center. If any term of this Agreement is to any extent invalid, illegal, or incapable of being enforced, such term shall be excluded to the extent of such invalidity, illegality, or unenforceability; all other terms hereof shall remain in full force and effect. Memberships are NOT TRANSFERABLE. PHOTO USE RELEASE: By registering for, participating in or attending Rushville Fitness and Community Center’s programs, events, or other activities, the participant (or parent/guardian of a minor participant) irrevocably agrees to the use and distribution by the Rushville Fitness and Community Center of his or her image (or of his minor child/ward) in photographs, video recordings, and any other electronic reproductions of such programs, events and activities for any purpose without inspection or approval and without compensation, rights to royalties or any other consideration now and in the future. 

ACKNOWLEDGEMENT OF RECEIPT & ACCEPTANCE: I, We, have read the above terms and conditions of membership and understand a  listing of terms, conditions and usage policies are available for my review at www.rushvillefitness.com.  I accept these terms, conditions, and usage policies as evidenced by my signature.  

Assumption of Risk and Waiver of Liability 

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is an extremely contagious disease and is believed to spread from person-to-person contact. The Rushville Fitness and Community Center has put in preventative measures to help reduce the spread of COVID-19; however, the Rushville Fitness and Community Center cannot guarantee that you will not become infected with COVID-19. Participation could increase the risk of contracting COVID-19.

 

READ CAREFULLY BEFORE SIGNING  

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed or infected by COVID-19.by participation; and that such exposure or infection may result in personal injury, illness, permanent injury, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the Rushville Fitness and Community Center may result from the actions, omissions, or negligence of myself and others, including but not limited to, the RFCC’s employees, volunteers, and program participants and their families. 

 

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself (including but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expenses, of any kind, that i may experience in connection with my participation at the Rushville Fitness and Community Center. On my behalf, I hereby release, covenant not to sue, discharge, and hold harmless the Rushville Fitness and Community Center, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or related thereto. I understand and agree that this release includes any Claims based on the action, omissions, or negligence of the Rushville Fitness and Community Center, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation at the Rushville Fitness and Community Center.

 

By signing this document, I agree that if I am exposed or infected by COVID-19 during my participation in this activity, then I may be found by a court of law to have waived my right to maintain a lawsuit against the parties being released on the basis of any claim for negligence.  If I have signed a separate general waiver of liability connected to my participation at the Rushville Fitness and Community Center, I agree that the terms of that waiver are wholly incorporated into this document and that the terms of this document are incorporated into the separate general waiver. 

 

I agree that I and my family will practice safe social distancing and clean hygiene during our participation at the Rushville Fitness and Community Center

Parent/ Guardian Additional Agreement 

In consideration of me and my family being permitted to participate in activities, I further agree to indemnify and hold harmless Releases from any claims alleging negligence which are brought by or on behalf of minor or are in any way connected with such participation by minor 

 

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!