Loading...

MOVEMENT TERRAIN LLC, PARTICIPATION WAIVER, ACKNOWLEDGEMENT AND ASSUMPTION OF RISK

176 COTTAGE AVE.WILBRAHAM MA 01095

Movement Terrain LLC.                                   

 

Membership / Participation Release and waiver of Liability, Assumption of Risk, And Indemnity and, Where applicable, Parental Consent Agreement (“Agreement”)

 Participant terms and waiver release of liability

Acknowledgment of Risks, Injury & Obligations

-I acknowledge that the activity I am to undertake is a dangerous activity and that by participating in it I am exposed to certain risks. I knowingly and freely assume all such risks, both known and unknown I incur as a result of my participation, or that of the MINOR, in participating in such activity:

-My personal property may be lost or damaged;

-Other persons participating in such activity may cause me injury or may damage my property

-I may cause injury to other persons or damage their property

-The conditions in which the activity is conducted may vary without warning

-I may be injured or die or suffer damage to my property as a result of the negligence or breach of contract of Movement Terrain LLC.

-There may be no or inadequate facilities for treatment or transport of me if I am injured.

-I assume the risk of and responsibility for any injury physically or mentally, death or property damage resulting from my participation in the activity.

I Agree
 

Release and Indemnity

-I knowingly participate in the activity at my sole risk and responsibility.

I release, indemnify and hold harmless Movement Terrain LLC, its servants and agents, from and against all and any actions or claims which may be made by me or on my behalf or by other parties for or in respect of or arising out of any injury, loss, damage or death caused to me or my property whether by negligence, breach of contract or in any way whatsoever.

Administration

-*Movement Terrain LLC. Reserves the right to change hours of operation and or lockout open gym for special events or any reason deemed necessary.

-Appropriate covered footwear & a shirt must be worn at all times while in the gym facility.

-Memberships are not refundable.

-All weights and equipment must be put back after use.

-Photo ID cards (i.e. student card or driver’s license) must be carried and shown upon request.

-Shared gym access with a non-member will result in forfeiture of membership effective immediately.  

-Each member must respect other gym users and behave in an appropriate manner at all times.

-Movement Terrain LLC. Staff reserves the right to rescind the rights of members not complying with the terms and conditions of the membership.  

-Anyone under the age of 16 must be accompanied by an adult at all times within the gym.

-I give permission to Movement Terrain LLC. To use photographs, film footage, or video recordings which may include my image or voice, or that of the MINOR, while participating in the activity, for purposes of promoting Movement Terrain LLC.

I Agree

 

I acknowledge that I am 18 or older, have read this agreement and fully understand its terms, I understand that I have given up substantial rights by signing it, I have signed it freely and without any inducement or assurance of any nature, and I intend to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid, the balance, notwithstanding, shall continue in full force and effect.

I, the MINOR’S parent and /or legal guardian, understand the nature of the activity and the MINOR’S experience and capabilities and believe the MINOR to be qualified, in good health, and in proper physical condition to participate in the activity. I hereby release, discharge, covenant not to sue, and agree to indemnify and save and hold harmless each of the releasees from all liability, claims, demands, losses, or damages on the MINOR’S account caused, or alleged to be caused, in whole or in part by the negligence of the releasees or otherwise, including negligent rescue operations and further agree that if, despite this release, I, the MINOR, or anyone on the MINOR’S behalf makes a claim against any of the releasees named, I will indemnify, save, and hold harmless each of the releasees from any litigation expenses, attorney fees, loss liability, damage, or any cost that may occur as a result of any such claim.

( must be 18 years and older to sign) 

I Agree

I understand that 6 is the minimum age for participation, I also understand I must pay to use (try) any equipment and signed waiver.

I Agree
 

 

 

 

 

 

First Participant's Name

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

Email*

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

Emergency Contact's Name*

Emergency Contact's Phone Number*
Reason for your visit?
Please choose reason for your visit today.*
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.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*

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!