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Comprehensive Liability Waiver for the Salt Mine, LLC

I hereby unconditionally release The Salt Mine, LLC. its entities, employees, instructors, agents, assigns and heirs from any and all liability resulting from any injuries, which may result from any classes, instruction and/or equipment at their studios. This release is irrevocable and is to cover any and all programs offered at The Salt Mine, LLC.  I also hereby agree to all of the following:

I acknowledge that participation in the exercises, movements, routines and activities offered at The Salt Mine, LLC. involve known, unknown, and unanticipated risks which could result in physical or emotional injury, paralysis, death and damage to myself, to property and to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of these exercises, movements, routines and activities. The risks include, but are not limited to, broken bones, sprains, strains and other soft tissue injuries, bruises, abrasions, lacerations, concussions, spinal cord injuries and dental damage.

I expressly agree and promise to accept and assume all of the risks existing in these exercises, movements, routines and activities. My participation in this activity is strictly voluntary, and I elect to participate in spite of the risks.

I represent and certify that I am in good physical condition to perform these exercises, movements, routines and activities, and further acknowledge that I am responsible for obtaining any medical release from my own physician to establish my readiness and fitness to perform these exercises, movements, routines and activities. I assume and bear the responsibility of all risks of loss or injury to person or property that may be created directly or indirectly by any such physical or mental condition of mine, whether or not actually known to me.

I understand The Salt Mine, LLC, its owner/employees/instructors are not medical personnel, may make no medical judgments, give no medical advice and provide no medical care or therapy to me.

I understand that any results from these exercises, movements, routines and activities are not guaranteed. I acknowledge that I have had the opportunity to ask questions and voice any concerns I may have with respect to these exercises, movements, routines and activities.

I agree to respect, honor and abide by any and all reasonable limits and/or restrictions that The Salt Mine, LLC. deem necessary to perform these exercises, movements, routines and activities.

I certify that I have adequate insurance to cover any injury or damage I may cause to myself, The Salt Mine, LLC., or others while participating in these exercises, movements, routines and activities; or else I agree to bear the costs of such injury or damage that I may cause to myself, The Salt Mine, LLC. or others.

I understand that use of all equipment including, but not limited to, poles, mats, stall bars, balls, chairs is at my own risk and I have had the opportunity to examine the equipment before use.

I hereby voluntarily release, forever discharge, agree to indemnify and hold harmless, The Salt Mine, LLC., its entities, employees, instructors, agents, assigns and heirs from any and all claims, demands damages or causes of action that may or could arise out of any loss, injury or damage to my person or property while participating in these exercises, movements, routines and activities.

In the event The Salt Mine, LLC., or anyone acting on its behalf is required to incur attorney’s fees and court costs to enforce this agreement, I agree to reimburse The Salt Mine, LLC., or any persons acting on its behalf, and/or hold harmless and indemnify The Salt Mine, LLC., for all fees, costs and expenses.

I agree that if any portion of this agreement is found void and unenforceable by any court of law; that the remaining portions of the agreement remain in full force and effect.

By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in these exercises, movements, routines and activities, I may be found by a court of law to have waived my right to maintain a lawsuit against The Salt Mine, LLC., its representatives, heirs, assigns and estate for any claim I might have for which I have released her from herein.

I further acknowledge that I have had sufficient opportunity to read this entire document, that I have read and understood it, and that I agree to be bound by all of its terms.

 

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*
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

Emergency Contact's 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.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

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.


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