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WAIVER AND RELEASE OF LIABILITY 

In consideration of gaining membership or being allowed to participate in the activities and programs of the UNC Hospital’s Wellness Center at Northwest Cary and to use its facilities, equipment, and machinery, I do waive, release, and forever discharge The UNC Hospital’s Wellness Center at Northwest Cary and its officers, agents, employees, representatives, executors, and all others from any and all responsibilities and liability for injuries or damages resulting from my participation in any activities or use of equipment or machinery in the above-mentioned facilities or arising out of my participation in any activities at said facility.

I understand and am aware that strength training, flexibility, and aerobic exercise, including the use of equipment, are a potentially hazardous activity.  I also understand that fitness activities involve a risk of injury and that I am voluntarily participating in these activities and using equipment and machinery with knowledge of the risks involved.  I hereby agree to expressly assume and accept any and all risks of injury resulting from use of equipment and/or from fitness activities.

I do hereby further declare myself to be physically sound and suffering from no condition, impairment, disease, infirmity, or other illness that would prevent my participation in any of the activities and programs of The UNC Hospital’s Wellness Center at Northwest Cary or use of equipment or machinery that I select.  I do hereby acknowledge that I have been informed of the need for a physician’s approval of my participation in an exercise/fitness activity or in the use of exercise equipment and machinery.  I acknowledge that I have either had a physical examination and have been given my physician’s permission to participate or that I have decided to participate in activity and/or use of equipment and machinery without the approval of my physician.  I hereby assume all responsibility for my participation and activities and utilization of equipment and machinery in my activities.

In the event of my inability to give consent, I do hereby authorize such first aid and/or medical and/or hospital care or treatment as deemed appropriate to treat any injury, which may occur as a result of my participation in the activities and programs of The UNC Hospital’s Wellness Center at Northwest Cary.

I have had an opportunity to ask questions.  Any questions I have asked have been answered to my complete satisfaction.  I understand the risks of my participation in The UNC Hospital’s Wellness Center at Northwest Cary and I voluntarily choose to participate, assuming all risks of injury due to my participation.

October 23, 2024

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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.
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 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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