Ludlow Mills, Stockhouse 218, Ludlow MA 01056

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 dangerous 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 due to 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.

WARNING: Flashing party lights may potentially trigger seizures for people with photosensitive epilepsy.

-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.


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

-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 cards or driver’s licenses) must be carried and shown upon request.

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

-Each member must respect other gym users and behave appropriately.

-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 16 must be accompanied by an adult at all times within the gym.

-I permit 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 to promote 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 I must pay to use (try) any equipment and sign a waiver.

I Agree






First Participant's Name

First Name*

Last Name*
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*
Parent or Guardian's Email Address


Confirm Email*
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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*

Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you consent to use your electronic signature in place of an original one 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, upon our written request, you may 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 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 ensure that we have a current email address to contact you regarding any necessary changes.

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