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This is our new standard health questionnaire and waiver. All participants in classes with the twisted fish need to complete this waiver before signing up for classes.

Waiver Form

AGREEMENT

1. In consideration of participating the “Activity”, I agree and acknowledge that I am fully aware that participation in the Activity involve risks and I accept all the risks of participating, even if the risks are created by the carelessness, negligence or gross negligence of a Released Party (as defined below) or anyone else.

2. “Claims” includes but is not limited to any and all liabilities, claims, demands, legal actions, rights of actions for damages, personal injury or death in connection with participation in the Activity. “Released Party” means the twisted fish or any of its affiliates, franchisees and their respective representatives, directors, officers, agents, employees or volunteer staff.

3. I agree and acknowledge that:

a. I am in proper physical condition to participate in the Activity, and am aware that participation could, in some circumstances, result in physical injury, serious physical injury or death.
b. I understand my physical limitations and am sufficiently self-aware to stop physical activity before I become ill or injured.
c. I am aware that if the Activity occurs outdoors, the streets adjourning the area of the Activity are open to regular vehicular traffic during the Activity and I will obey all traffic laws and regulations.

4. I accept full responsibility for any product or technology loaned to me as part of participation in this Activity and commit to return the same in good working order.

5. I hereby, for myself and for my heirs, next of kin, executors, administrators and assigns, fully release, waive and forever discharge any and all rights or Claims I may have, now or in the future, against any Released Party, even if the Claims are based on the carelessness, negligence or gross negligence of a Released Party or anyone else. Without limiting the foregoing, I further release any recourses which I may now or hereafter have resulting from any decision of any Released Party.

6. I agree not to sue any Released Party for Claims, even if the Claims arise from the carelessness, negligence or gross negligence of any Released Party or anyone else. I agree to indemnify (reimburse for any loss) and hold harmless each Released Party from any loss or liability (including any reasonable legal fees they may incur) defending any Claim made by me or anyone making a Claim on my behalf, even if the Claim is alleged to or did result from the carelessness or negligence of any Released Party or anyone else.

7. I am aware that there is no obligation for any person to provide me with medical care during the Activity. I understand and acknowledge that:

a. there may be no aid stations available for the Activity.
b. if medical care is rendered to me, I consent to that care if I am unable to give my consent for any reason at the time the care is rendered.

8. I am aware that it is advisable to consult a physician prior to participating in the Activity. If I have consulted a physician, I have taken the physician’s advice.

9. I grant my permission to the Released Party and any transferee or licensee or any of them, to utilize any photographs, motion pictures, videotapes, recordings and other references or records of the Activity which may depict, record or refer to me for any purpose (“Likeness”), including commercial use by the released parties, their sponsors and their licensees. This permission is for use anywhere in the world and on the Internet and for an unlimited period of time. I understand and agree that I will not be compensated or receive additional consideration for consenting to the use of my Likeness and that I will not be given a chance to receive, inspect or approve the promotional or marketing material, messages and/or content that may use my Likeness.

10. No warranties or representations have been made to me about the Activity which are not stated on this form. I understand and intend that this document act as the broadest and most inclusive assumption of risk, waiver, release of liability, agreement not to sue and indemnity.

11. If any provision of this agreement shall be unlawful, void or for any reason unenforceable, then that provision shall be deemed severable from this agreement and shall not affect the validity and enforceability of any remaining provisions.

12. I have fully read and understand this agreement. I am aware that by signing this agreement, I am waiving certain legal rights I or my heirs, next of kin, executors, administrators and assigns may have against the Released Party.

13. I hereby acknowledge that I may be required to use an automobile to travel to and from the Activity or as part of the Activity. I hereby acknowledge that I have the authority to use such automobile and that the automobile is fully insured for use in the Activity. I accept full responsibility for the automobile and that use of the automobile in the Activity will be at my own risk.

I also understand that (please initial);

All payments are non-refundable and non- transferrable for any reason, including, but not limited to vacation, illness and injury.

The scheduling and content of activities may be changed on occasion.

All N.S.F. cheques will be charged a $50.00 (CDN) fee.

I will notify instructors immediately of any pain and/or major discomfort felt during any activity.

I am responsible for bringing my required equipment to every activity (where applicable).

If I am pregnant or plan to become pregnant during course of the Activity, I will submit a ParMED-X for Pregnancy, a guideline for health screening prior to participation in a fitness class.

Date: August 8, 2020

Please select who will be participating...
AdultMinor
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First Participant's Name

First Name*

Last Name*

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

RISK ASSESSMENT

Heart Disease*
Shortness of Breath or Chest Pain*
Inhaler?*

(if "yes", please bring it to every class)

High Blood Pressure*

Levels:
Do you take medication for HBP?*
High Cholesterol Level*
Significant Bone/Joint/Muscle Pain*

Location:
Back Pain*
Abnormal Resting EKG*
Diabetes*
Insulin Dependent?*
Pregnant or planning on becoming pregnant?

Post natal? How many weeks?

Any other? Please explain:
Are you active?*

Activity or Exercise:

Times per week:

Minutes per session:
Are you currently taking any medication(s)?*

Type:

What are other regular therapies do you use (eg. massage, physiotherapy)?

Do you currently have any of the following symptoms:

Fever/feverish, new or existing cough?*
Difficulty breathing?*
Have you had close contact with a confirmed or probable case of COVID 19*
Have you been out of Canada in the past 14 days?*
Have you had contact with a person with respiratory illness who has been outside Canada in the last 14 days?*

BY SIGNING BELOW, Participant accepts and agrees to the terms and provisions contained in this agreement

First Participant's Signature*
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*

Last Name*

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

RISK ASSESSMENT

Heart Disease*
Shortness of Breath or Chest Pain*
Inhaler?*

(if "yes", please bring it to every class)

High Blood Pressure*

Levels:
Do you take medication for HBP?*
High Cholesterol Level*
Significant Bone/Joint/Muscle Pain*

Location:
Back Pain*
Abnormal Resting EKG*
Diabetes*
Insulin Dependent?*
Pregnant or planning on becoming pregnant?

Post natal? How many weeks?

Any other? Please explain:
Are you active?*

Activity or Exercise:

Times per week:

Minutes per session:
Are you currently taking any medication(s)?*

Type:

What are other regular therapies do you use (eg. massage, physiotherapy)?

Do you currently have any of the following symptoms:

Fever/feverish, new or existing cough?*
Difficulty breathing?*
Have you had close contact with a confirmed or probable case of COVID 19*
Have you been out of Canada in the past 14 days?*
Have you had contact with a person with respiratory illness who has been outside Canada in the last 14 days?*

BY SIGNING BELOW, Participant accepts and agrees to the terms and provisions contained in this agreement

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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