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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 consent to voluntarily participate at Funkytown Fitness and its various classes and fitness offerings.

I acknowledge that the Programs may include activities that can be strenuous and participation in such programs involves inherent risks, which could lead to bodily injury, impairment, disability, or even death.

I understand the risks involved in my participation in the Programs and agree to cease my participation in the Programs or any specific exercise if I feel that such participation is too strenuous or places me at specific risk of injury.

In no event shall Funkytown Fitness, its officers, employees, or instructors, be held liable for any personal injury, death, or property loss or damage sustained resulting from my participation in any/all activities in connection with Funkytown Fitness.

I also hereby release all those mentioned and any others acting upon their behalf from any responsibility or liability for any injury or damage to myself, including those caused by the negligent act or omission of any of those mentioned, or others acting on their behalf or in any way arising out of or connected with my participation in any activities of Funkytown Fitness or the use of its facilities.

Unless amended by mutual agreement, this instrument shall remain binding and in effect so long as I am a member of Funkytown Fitness and/or a participant in any of its classes or programs.

I have read and understand this document in its entirety.

Dated: June 16, 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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