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April 26, 2024

H.I.T. Center of RI, LLC

All parents or guardians of any member or guest’s child (under 18) that wish to participate in any H.I.T. Center of RI, LLC program or activity must complete the following child program release form before his/her child may begin the program or activity.

A copy of this form will be saved electronically, and also emailed to the Parent/Guardian in .pdf format once the form is completed, for future reference.

Acknowledgment, Assumption of Risk and Waiver of Liability  

I do hereby assume full responsibility for any and all damages, injuries (including death), or losses that my child may sustain or incur, if any, while attending, practicing, participating, or witnessing in any H.I.T. Center of RI, LLC facility exercise program, sport, or physical activity occurring in or about the center premises or at any offsite location. I hereby assume full risk, waive all claims, and release and hold, it’s owners, instructors, or partners of said program or event, individually or otherwise, harmless for any and all claims for injuries or damages.

I am fully aware and understand that the H.I.T. Center of RI, LLC does not have on or about the center premises, or employ or contract with any medical services, provisions for ordinary or emergency medical services.

In addition, I understand that my participation in this activity (whether for practice or performance) involves activities and risks incidental thereto including, but not limited to, participation at H.I.T. Center of RI, LLC and exposure to the possible reckless conduct of other participants.  Nevertheless, I voluntarily elect to participate in this activity with knowledge of the potential danger involved, and I hereby agree to accept and assume any and all risks of property damage, personal injury, or death.

In consideration of my child’s participation in and the use of the H.I.T. Center of RI, LLC facility, I hereby release and covenant not to sue the H.I.T. Center of RI, LLC, its owners, shareholders, directors, officers, employees, representatives, agents, and lessees from any and all claims resulting from any physical injury that may occur to my child while participating in any program or event sponsored by H.I.T. Center of RI, LLC.

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COVID-19

I am fully aware that the novel coronavirus (“COVID-19”) is an extremely contagious virus and that it is currently believed that COVID-19 spreads through person-to-person contact. I am familiar with the Center for Disease Control and Prevention (”CDC”) guidelines regarding COVID-19, which are located at https://www.coronavirus.gov.

I acknowledge and understand that the circumstances regarding COVID-19 are changing from day-to-day, and that the CDC guidelines are regularly modified and updated. I accept full responsibility for familiarizing myself with the most recent updates, and making informed choices to take precautionary measures to protect myself and others. 

In addition to the CDC guidelines, I agree to abide by any and all policies or postings published to the general public at the H.I.T. Center of RI, LLC.

By signing this agreement, I acknowledge that I am aware of the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 at the H.I.T. Center of RI, LLC, 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 at the H.I.T. Center of RI, LLC may result from the actions, omissions, or negligence of myself and others.

I agree that, in the event that I suspect I or my child(ren) became exposed to or infected by COVID-19 at the H.I.T. Center of RI, LLC and I elect to seek testing and/or treatment as a result therefrom, I will be responsible for payment of any and all medical services and testing services.

I voluntarily choose to assume all of the foregoing risks and accept sole responsibility for any injury, illness, permanent disability, or death related to COVID-19 arising from or in connection with my presence at the H.I.T. Center of RI, LLC. I hereby release and hold harmless H.I.T. Center of RI, LLC, their employees, agents, directors, officers and representatives and other participants from and against all liabilities (statutory or otherwise) for claims, suits, demands, judgments, costs, interest and expense (including but not limited to attorney’s fees and disbursements) for injury, illness, permanent disability, or death related to COVID-19 arising from or in connection with mine or my child(ren)’s presence at the H.I.T. Center of RI, LLC, EVEN IF ARISING FROM THE NEGLIGENCE, ACTS OR OMISSIONS OF THE RELEASED PARTIES.

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Except for claims and recoveries resulting from gross negligence,

  1. I hereby voluntarily waive any and all claims that I may make, both present and future, and
  2. I relinquish the right to recover for injury or death. (To clarify, this waiver and relinquishment is on behalf of, and binding upon, me and anyone else associated with me.)

I understand that this waiver is to be construed by the laws of the State of Rhode Island and is intended to be as broad and inclusive as those laws permit. I agree that if any portion is held invalid, the remainder of the waiver will continue in full legal force and effect. I further agree that the venue for any legal proceedings involving these matters shall be in the State of Rhode Island.

I HAVE READ AND FULLY UNDERSTAND THE ABOVE "ACKNOWLEDGMENT, ASSUMPTION OF RISK AND WAIVER OF LIABILITY" AND FULLY UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS, INCLUDING THE RIGHT TO SUE, BY SIGNING THIS WAIVER VOLUNTARILY. PARENTS OR GUARDIANS MUST SIGN IF APPLICANT IS UNDER 18.

I Agree



First Parent or Legal Guardian Name

First Name*

Last Name*

Phone*
First Parent or Legal Guardian Age Acknowledgment*
First Parent or Legal Guardian Date of Birth*
I certify that I am 18 years of age or older
First Parent or Legal Guardian Signature*
Second Parent or Legal Guardian Name

First Name*

Last Name*
Second Parent or Legal Guardian Date of Birth*
Third Parent or Legal Guardian Name

First Name*

Last Name*
Third Parent or Legal Guardian Date of Birth*
Fourth Parent or Legal Guardian Name

First Name*

Last Name*
Fourth Parent or Legal Guardian Date of Birth*
Fifth Parent or Legal Guardian Name

First Name*

Last Name*
Fifth Parent or Legal Guardian Date of Birth*
Sixth Parent or Legal Guardian Name

First Name*

Last Name*
Sixth Parent or Legal Guardian Date of Birth*
Seventh Parent or Legal Guardian Name

First Name*

Last Name*
Seventh Parent or Legal Guardian Date of Birth*
Eighth Parent or Legal Guardian Name

First Name*

Last Name*
Eighth Parent or Legal Guardian Date of Birth*
Ninth Parent or Legal Guardian Name

First Name*

Last Name*
Ninth Parent or Legal Guardian Date of Birth*
Tenth Parent or Legal Guardian Name

First Name*

Last Name*
Tenth Parent or Legal Guardian Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive H.I.T. Center information and news by e-mail.
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*

Relationship*

Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
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.


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