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Informed Consent & Liability Waiver

Special Event

Description of the Exercise Program

I understand that the exercise program will involve participation in a wide variety of types of fitness activities. These activities will vary depending upon the established objectives, but will probably include:

1) Aerobic activities including, but not limited to, the use of treadmills, stationary bicycles, step machines, rowing machines, and running track;
2) Muscular endurance and strength building exercises including, but not limited to, the use of free weights, weight machines, calisthenics, elastic bands, exercise balls of all kinds, corrective exercises, and other exercise apparatus;
3) Other activities selected by the strength and conditioning coach and agreed upon by client;
4) And selected physical fitness, health screenings, movement assessments, and body composition tests.

Waiver and Liability
In consideration of using the services of Revival Fitness & Rehab LLC (hereafter referred to as Revival), on behalf of myself, my heirs, personal representatives, or assigns, I do hereby release, waive, discharge, and covenant not to sue Revival, Amtran their owner(s), officers, employees, volunteers, and agents, from liability regarding any and all claims arising from the ordinary negligence of Revival, Amtran or any of the aforementioned parties.

This agreement applies to 1) personal injury (including death) from accidents or illnesses arising directly or indirectly from participation in activities directed, suggested, or planned by Revival and Amtran including, but not limited to, organized activities, classes, instruction, observation, competitions, related activities in a non-supervised setting, and use of facilities, premises, or equipment; and to 2) any and all claims resulting from the damage to, loss of, or theft of property.

Indemnification and Hold Harmless
I also agree to hold harmless and indemnify Revival, Amtran, and their owners, officers, employees, volunteers, agents, and insurance carriers from all claims (whether initiated by me or by a third party) and to reimburse them for any expenses incurred as a result of my involvement with Revival and Amtran. I further agree to pay all expenses, including court costs and attorneys’ fees, incurred by Revival, Amtran, and the aforementioned parties in investigating and defending a claim or suit resulting from my participation in any Revival fitness, rehab, corrective exercise, sports performance, and conditioning activities.

Assumption and Description of Inherent Risks
The trainers, strength and conditioning coaches, and/or event director has explained that no fitness competition/fitness event is without inherent risks and that, regardless of the care taken by the strength and conditioning coach/trainer/volunteer, he or she cannot guarantee the personal safety of the client. Fitness, rehab, and conditioning activities, by their very nature, carry with them certain inherent risks that cannot be eliminated regardless of the care the personal trainer takes to prevent injuries. The competition events, sports performance, personal training and rehab services offered by Revival provide for activities such as weight lifting, walking, jogging, running, jumping, crawling, stretching, myofascial work, and other related anaerobic and aerobic activities. Some of these involve strenuous exertions of strength using various muscle groups, some involve quick movements involving speed and change of direction, and others involve sustained physical activity that places stress on the cardiovascular system. In addition, many activities will involve equipment (e.g., barbells, free weights, weighted balls) and complex machines (e.g., treadmills, stepping machines, stationary bicycles) — all of which have the potential of malfunctioning or causing injury.

Injuries can range from occasional minor injury (e.g., pulled muscles, muscle soreness) to infrequent serious injury (e.g., heart attack, stroke, or other cardiovascular accidents) to the very rare catastrophic incident (e.g., death, paralysis). Likewise, I know that engaging in muscular endurance, strength building, and other fitness activities occasionally results in minor injuries (e.g., bruises, musculoskeletal strains and sprains), infrequently, more serious injuries (e.g., muscle tears, herniated disks, torn rotator cuffs), and very rarely, catastrophic injury (e.g., death, paralysis).

I realize that when participating in any exercises or conditioning activity, there is always a possibility that minor injuries, major injuries, or catastrophic injury/death may occur. I have read the previous paragraphs and know the nature of the activities at Revival. I understand the demands of those activities relative to my physical condition and skill level, and I appreciate the types of injuries that may occur as a result of activities made possible by Revival. I hereby assert that my participation is voluntary and that I knowingly and willingly assume all such risks.

Severability and Venue
I further expressly agree that the foregoing waiver and assumption of risk agreement is intended to be as broad and inclusive as is permitted by the law of the State of Pennsylvania and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. Likewise, I agree that if legal action is brought, it must be brought in the District Court or the Federal Court residing where the incident occurred.

Acknowledgment of Understanding
I have read this waiver of liability and indemnification agreement and fully understand its terms. I understand that I am giving up substantial rights, including our right to sue. I acknowledge that I am signing the agreement freely and voluntarily, and intend my signature to be a complete and unconditional release of all liability for injury resulting from ordinary negligence to the greatest extent allowed by law in the State of Pennsylvania.

Client Responsibilities
I understand that it is my responsibility to:

1) Fully disclose any health issues (including diabetes, heart problems, seizures, and asthma) or medications that are relevant to participation in a strenuous exercise program;
2) Inform the coach/trainer/volunteers if there are activities with which the client does not feel comfortable;
3) Cease exercise and report promptly any unusual feelings (e.g., chest discomfort, nausea, difficulty breathing, apparent injury) during the exercise program; and
4) Clear the client’s participation with a physician.

Client Acknowledgements
In agreeing to this competition, I the client:

  • Acknowledge that my participation is completely voluntary.
  • Understand the potential physical risks involved in the fitness competition and believe that the potential benefits outweigh those risks.
  • Give consent to certain physical touching that may be necessary to ensure proper technique and body alignment.
  • Understand that the achievement of health or fitness goals cannot be guaranteed.
  • Have been able to ask questions regarding any concerns the client might have, and have had those questions answered to the client’s satisfaction.
  • Am in good physical condition, have no impairment, which might prevent my participation in such activities, and have been advised to consult a physician prior to beginning this program.
    • If not in good physical condition, have been approved by a physician to begin general exercise and/or corrective-exercise program.
  • Have been advised to cease exercise immediately if the client experience unusual discomfort and feel the need to stop.

 

Photograph/Video Release

We consent to any collection and usage of pictures and videos taken during trainings at/with Revival. Pictures/videos may be used at Revival's discretion in relation to anything related to promotion materal, advertising, website, and business related. 

 

Acknowledgment of Understanding: I have read this waiver of liability, indemnification and assumption of risk agreement and fully understand its terms. I have been made fully aware of and understand the potential risks involved in this physical strength and conditioning/sports rehab program. I understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing the agreement freely and voluntarily and intend my signature to signify a complete assumption of the inherent risks in any way associated with the personal training and rehab programs offered by Revival to the greatest extent allowed by law in the State of Pennsylvania.

Today's Date: October 20, 2020

First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
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

Email*

Confirm Email*
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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*

Last Name*

Relationship*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
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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