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Funkytown Fitness

~Find your Groove~

105 Southpark Blvd. St.Augustine, FL 32080

(904)770-2391

funkytownfit@gmail.com

Informed Consent for Exercise Participation and Waiver Release

I acknowledge my participation in various fitness classes services or modalities offered by FUNKYTOWN FITNESS and all instructors expose me to a possible risk of personal injury. Iknowingly and freely assume all such risks, both unknown and known. I acknowledge that I mayengage in both privately supervised, group supervised or unsupervised activity and I assume all risks of using equipment, movement or exercise routines or props with or without staff present. In addition, I acknowledge that the business may include outdoor activities, which may present risks such as slippery surfaces, uneven surfaces, loose rocks/gravel, unseen landscaping issues or more. 


I hereby release, indemnify and hold harmlessFUNKYTOWN FITNESS, all instructors and trainers and the owners of this business or any other business that may be associated with this company, with respect to any and all injury, disability, death, loss or damage to person or property that may arise out of connection with this business or any use of its products, services or classes.


I will never continue with a movement/class that is too difficult for my level of comfort or ability. I agree to inform my instructor/practitioner of any prior outstanding injuries, physical limitations, and physical discomfort I am experiencing before/during class and take full responsibility for nonclosure.


I grant FUNKYTOWN FITNESS my permission for photograph, video, or other digital media taken during class to be used within publications/websites/social media.


I expressly agree that this release is intended to be as broad and inclusive as permitted by applicable law and if a portion of this release is held invalid the balance shall remain in full force and effect. This release shall apply to my heirs, assigns, personal representatives and any other next of kin. I understand that this business is relying on this release in agreeing to enter into this agreement.


I have read the release of liability and assumptions of risk agreement and fully understand itsterms and that I have given up substantial rights by signing It and I sign it freely andvoluntarily without inducement.

Dated: July 6, 2026

First Participant's Name
First Name*
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
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.
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*
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.


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