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MINOR HEALTH & FITNESS LIABILITY WAIVER

I, _______________ (parent/legal guardian) consent to the following for (minor child): My child is voluntarily participating in an exercise class, card lo-training, strength-training or personal training program at DME Fitness. I recognize that the programs/classes require physical exertion that may be strenuous at times and may cause physical injury and I am fully aware of the risks and hazards involved. I understand that it is my responsibility to consult with a physician prior to and regarding my child's participation in the above programs/classes or use of equipment. I represent and warrant that my child has no medical condition that would prevent his/her participation in the programs/classes. I agree to assume full responsibility for any risks, injuries or damage known or unknown which my child may incur as a result of participating in the programs, classes or use of equipment. Such Injuries may include, but are not limited to, heart attacks, muscle strains, muscle pulls, muscle tears, broken bones, shin splints, heat prostration, Injuries to knees, injuries to back, injuries to foot, or any other illness or soreness, including death. I knowingly and voluntarily and expressly waive any claim I may have against DME Fitness or any Instructor, employee, officers, owners, personal trainer or volunteer of DME Fitness for injury or damages that my child may sustain as a result of participating in the programs, classes or by use of equipment. I, my heirs or representatives forever release waive, discharge and covenant not to sue DME Fitness, its employees, officers, owners and sub-contractors for any injury or death caused by their negligence or other acts. I understand that misuse of equipment may result in injury. I understand the minor membership policies set by DME Fitness. I understand that failure to follow these policies or misuse of equipment Is a direct violation of the membership agreement and may result in revocation of my child's membership. I consent to allow DME Fitness to collect my child's photograph, by capturing my Image at DME Fitness for Identifying him/her as a member, volunteer or program participant. DME Fitness periodically takes pictures or video of DME Fitness members and persons participating in programs/classes to use tor promotional purposes and programming materials including social media and the DME Fitness website. I have read the above waiver and release of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above. Parent/Guardian Signature: _____________________ Date: ______________ Parent/ Guardian Name (Print): __________________________________________ Parents Email_________________________ Phone:________________________ Minor Name: ______________________________ DOB: _______________ Minor Member Signature (lf comprehends): __________________________________ Minor’s sports: _________________________________________________________

First Participant's Name
First Name*
Middle Name
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant's Signature*
Second Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email*
Confirm Email*
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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*
Middle 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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