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Assumption of Risk and Waiver of Liability Due to COVID-19

 

THIS RELEASE IS A BINDING LEGAL CONTRACT.   PLEASE READ IT CAREFULLY BEFORE SIGNING.

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. It may also be spread by contact with contaminated surfaces or by exposure to particles in the air. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people.

Pine Brook Fitness LLC, which includes its subsidiaries New Rochelle Racquet Club LLC, The Rock Club LLC, and The Studios at PBF, LLC (collectively, “Pine Brook Fitness”) has put in place numerous preventative measures to reduce the spread of COVID-19; however, Pine Brook Fitness cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, visiting Pine Brook Fitness or participating in Pine Brook Fitness activities or events could increase your risk and your child(ren)’s risk of contracting COVID-19.

By signing this agreement, I acknowledge that I have read and understood this warning and the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by visiting Pine Brook Fitness or participating in Pine Brook Fitness activities or events and that such exposure or infection may result in personal injury, illness, permanent disability, or death. I understand and assume the risk that becoming exposed to or infected by COVID-19 at Pine Brook Fitness may result from the actions, omissions, or negligence of myself or others, including , but not limited to, Pine Brook Fitness employees, volunteers, or other visitors.

On my behalf, and on behalf of my child(ren), I hereby release, covenant not to sue, discharge, and hold harmless Pine Brook Fitness, its members, officers, employees, agents and representatives, of and from all claims, liabilities, actions, damages, costs or expenses of any kind whatsoever (the “Claims”) arising out of or relating to personal injury, illness, permanent disability, or death due to exposure to or infection from COVID-19 while visiting Pine Brook Fitness or participating in a Pine Brook Fitness activity or event. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of Pine Brook Fitness, its employees, agents or representatives.

I HAVE CAREFULLY READ AND FULLY UNDERSTAND ALL THE PROVISIONS OF THIS ASSUMPTION OF RISK AND RELEASE

I Agree

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*
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 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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