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B3Better
11339 Distribution Ave E.
Jacksonville FL, 32256
904-329-3222

 

PARTICIPANT RELEASE OF LIABILITY
PLEASE READ BEFORE SIGNING

In consideration of being allowed to participate in any way in the program, related to events and activities, I the undersigned, acknowledge, appreciate, and agree that:

  • The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce the risk, the risk of serious injury does exist and,
  • I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES or others, and assume full responsibility for my participation; and,
  • I willingly agree to comply with the stated and customary terms and conditions for participation. If however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately and,
  • I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS B3Better, their officers, officials, agents and/or employee, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners, and lessons of premises used to conduct the event (RELEASES), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASES OR OTHERWISE, to the fullest extent permitted by law.

  • B3 Better or any party designated by B3 Better may photograph or film me while I attend the proogram(s) of B3 Better and use of any and all such photos, video footage and/or video streaming for promotion, sales, publicity and advertising purposes for all media, including, but not limited to, the internet.

  • B3 Better or any party designated by B3 Better may photograph or film me while I attend the proogram(s) of B3 Better and use of any and all such photos, video footage and/or video streaming for promotion, sales, publicity and advertising purposes for all media, including, but not limited to, the internet.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

I Agree

June 17, 2026

Please select who will be participating...
AdultMinor
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First Participant's Name
First Name*
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant's Signature*
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.
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
Preparticipation Screening Questionnaire

Have had or do you have: (please check all that apply)

A heart attack
Heart Surgery
Cardiac catheterization
Coronary angioplasty
Pacemaker
Defibrillator/rhythm disturbance
Heart valve disease
Heart failure
Heart transplantation
Congenital heart disease
You have diabetes
You have asthma or other lung disease
You have burning or cramping sensations in your lower legs when walking short distances
You have musculoskeletal problems that limit your physical activity
You have concerns about the safety of exercise
You take prescription medications
You are pregnant
None of the Above

If you selected any of the above, please give more description below:

 Has anyone in your immediate family had: (please check all that apply)

A heart attack
Heart surgery
Cardiac catheterization
Coronary angioplasty
Pacemaker
Defibrillator/rhythm disturbance
Heart valve disease
Heart failure
Heart transplantation
Congenital heart disease
Diabetes
None of the Above

If you selected any of the above, please give more description below:

If you have answered yes to any of the preceding questions concerning yourself, consult your physician.

You may need a facility with a medically trained personnel

Symptoms

You experience chest discomfort with exertion*
You experience unreasonable breathlessness*
You experience dizziness, fainting, or blackouts*
You take heart medications*

 Cardiovascular Risk Factors

You are a man older than 45*
You are a woman older than 55; have had a hysterectomy, or are postmenopausal

 Other Cardiovascular Risk Factors

Please select all of the factors that apply below: 

You smoke or quit smoking within the previous 6 months.
You do not know your blood pressure
Your blood pressure is 140/90
You take blood pressure medication
You are physically inactive (you get 30 min. of physical activity on at least 3 days per week)
Your blood cholesterol level is 200
You do not know your cholesterol level
You have a immediate blood relative who had a heart attack or heart surgery before the age of 55 (father or brother) or age 65 (mother or sister)
You are 20 pounds overweight.
None of the Above

If you checked one or more of the statements in this section, you will need to consult your physician before beginning any exercise. 

We do strongly feel you will benefit from our highly qualified professional staff, but we want you to do so with all precaution. 


Other health issues
This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree his/her release as provided above all the Releases, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releases from any and all liability incidents to my minor child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.


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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