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Assumption of Risks, Release of Liability and Indemnification for Dogs

I, ("Participant") desires to use and bring my dog(s) to the facilities and/or programs of The Rock Club LLC, the New Rochelle Racquet Club LLC, The Studios LLC and/or Pine Brook Fitness LLC, all of 130 Rhodes St, New Rochelle, New York ("The Club"). In consideration of The Club permitting said use, I hereby agree to be bound by the terms of this Assumption of Risks, Release of Liability and Indemnification and by the provisions of the Rules and Regulations of The Club (together, the "Release").

I understand that I have full responsibility over my dog(s). Full responsibility includes but is not limited to financial responsibility for anything my dog(s) damages. I understand that my dog must be leashed at all times and well-behaved. Well-behaved means that the dog will not jump up onto people unless invited, will not bite, nip, or otherwise place their teeth on anyone, will not bark excessively, will not urinate or defacate indoors. I have provided TRC with the following documents:

  1. Up-to-date vaccination records for all legally-required vaccinations in NY.
  2. A written and signed recommendation letter from my dog's veterinarian that the dog is of good behavior and is safe to have arounds people including kids in a highly-stimulating enviroment. This letter must be made out to The Rock Club.

I understand that it is my responsibility to provide TRC with their renewed vaccination records before the current vaccination expires. If any vaccination expires, the dog is not allowed in the gym until they vaccinations are renewed. I agree to clean up after my dog(s) should they have an accident indoors or should they shed excessively.

I Agree

The Club reserves the right to use any photograph or video taken at The Club or in the course of Programs for promotional materials, brochures, social media, and/or website, whether in the course of a Program, open climbing, birthday party, private group or otherwise.  The Club retains exclusive rights such photographs and videos.

The Club reserves the right to refuse entry, use of the Club equipment, property, or from participation in any activity at any time for any reason whatsoever.

May 28, 2020

First Participant Name

First Name*

Middle Name

Last Name*

Phone*
First Participant Date of Birth*
First Participant Information

Dog's name? *

Dog Breed? *

Dog's Birthdate *
Are all vaccinations up to date? *
Yes
No
First Participant Signature*
Second Participant Name

First Name*

Middle Name

Last Name*
Second Participant Date of Birth*
Second Participant Information

Dog's name? *

Dog Breed? *

Dog's Birthdate *
Are all vaccinations up to date? *
Yes
No
Third Participant Name

First Name*

Middle Name

Last Name*
Third Participant Date of Birth*
Third Participant Information

Dog's name? *

Dog Breed? *

Dog's Birthdate *
Are all vaccinations up to date? *
Yes
No
Fourth Participant Name

First Name*

Middle Name

Last Name*
Fourth Participant Date of Birth*
Fourth Participant Information

Dog's name? *

Dog Breed? *

Dog's Birthdate *
Are all vaccinations up to date? *
Yes
No
Fifth Participant Name

First Name*

Middle Name

Last Name*
Fifth Participant Date of Birth*
Fifth Participant Information

Dog's name? *

Dog Breed? *

Dog's Birthdate *
Are all vaccinations up to date? *
Yes
No
Sixth Participant Name

First Name*

Middle Name

Last Name*
Sixth Participant Date of Birth*
Sixth Participant Information

Dog's name? *

Dog Breed? *

Dog's Birthdate *
Are all vaccinations up to date? *
Yes
No
Seventh Participant Name

First Name*

Middle Name

Last Name*
Seventh Participant Date of Birth*
Seventh Participant Information

Dog's name? *

Dog Breed? *

Dog's Birthdate *
Are all vaccinations up to date? *
Yes
No
Eighth Participant Name

First Name*

Middle Name

Last Name*
Eighth Participant Date of Birth*
Eighth Participant Information

Dog's name? *

Dog Breed? *

Dog's Birthdate *
Are all vaccinations up to date? *
Yes
No
Ninth Participant Name

First Name*

Middle Name

Last Name*
Ninth Participant Date of Birth*
Ninth Participant Information

Dog's name? *

Dog Breed? *

Dog's Birthdate *
Are all vaccinations up to date? *
Yes
No
Tenth Participant Name

First Name*

Middle Name

Last Name*
Tenth Participant Date of Birth*
Tenth Participant Information

Dog's name? *

Dog Breed? *

Dog's Birthdate *
Are all vaccinations up to date? *
Yes
No
Parent or Guardian's Email Address

Email
Check to receive information, news, and discounts by e-mail.
A signed copy of this waiver will be sent to the email address you provide.
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 Information

Dog's name? *

Dog Breed? *

Dog's Birthdate *
Are all vaccinations up to date? *
Yes
No
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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