Loading...


action athletics Liability Release with COVID addendum and COVID Health Form

PARTICIPANT WAIVER AND RELEASE OF LIABILITYAND HOLD HARMLESS AGREEMENT

TODAY'S DATE: October 26, 2021

THE UNDERSIGNED ACKNOWLEDGES AND AGREES THAT THE USE OF EQUIPMENT/OBSTACLES PROVIDED BY ACTION ATHLETICS, AS WELL AS PARTICIPATION IN ANY ACTIVITY AT ACTION ATHLETICS, EITHER ON MY OWN OR UNDER THE INSTRUCTION/SUPERVISION OF ACTION ATHLETICS EMPLOYEES, IS ENTIRELY VOLUNTARY, AT THE SOLE DISCRETION AND JUDGMENT OF THE UNDERSIGNED, AND AT HIS OR HER OWN RISK.

The undersigned participant acknowledges and agrees that there are substantial risks, hazards and dangers inherent in participating in activities at Action Athletics and on equipment/obstacles provided by Action Athletics. Such risks, hazards and dangers may include, but are not necessarily limited to, injury to the musculoskeletal and/or cardio respiratory systems which can result in serious injury or death. This Waiver and Release of Liability and Hold Harmless Agreement covers, without limitation, all injuries and property damage which may occur as a result of the participants use of all amenities and equipment provided by Action Athletics as well as his or her participation in any activity, class, program, personal training, supervised activity, or instruction, or as a result of the sudden and/or unforeseen malfunctioning of any equipment.

With this knowledge and understanding, and in consideration of the services and activities provided by Action Athletics, the participant states as follows:

  • The participant hereby waives, releases, remises, covenants not to sue and forever discharges Action Athletics, Stage 4 Designs, The Bernardi Family Trust and any of their officers, agents and employees, of any and all liability, claims, demands, actions or rights of action, or damages of any kind including, but not limited to those related to, arising from, or in any way connected with participation in Action Athletics programs/classes/events, including those allegedly resulting from or in any way related to the negligent acts or omissions of Action Athletics and/or its officers, agents and/or employees or the malfunction of Action Athletics' or Stage 4 Designs equipment or obstacles.
  • The participant accepts full financial responsibility for any injury to him/herself or to any other participant, whether due to his/her own negligence or not, and agrees to hold harmless and indemnify Action Athletics, Stage 4 Designs, The Bernardi Family Trust, and their officers, agents and employees from any loss, liability, claims, damages or costs, including court costs and attorneys fees, that they may be sought against Action Athletics, Stage 4 Designs, and/or the Bernardi Family Trust due to his or her participation.
  • The participant understands that this Waiver and Release of Liability and Hold Harmless Agreement shall apply to any and all services and activities at Action Athletics from this date forward.
  • The participant certifies that he or she has no medical problems that would increase the risk of illness, injury and/or death as a result of participation in a fitness program or any other activity facilitated and/or designed by Action Athletics.
  • Action Athletics, Stage 4 Designs, and the Bernardi Family Trust are not responsible for any lost, stolen or damaged personal belongings.

By signing below, you are acknowledging and agreeing (or acknowledging and agreeing on behalf of your child if under 18) that you have carefully read and are agreeing to release and discharge Action Athletics, Stage 4 Designs, The Bernardi Family Trust, and their officers, agents and employees, from any and all claims, causes of action and damages, and are agreeing voluntarily to give up or waive any right that you may otherwise have to bring a legal action against Action Athletics, Stage 4 Designs, The Bernardi Family Trust, and their officers, agents and employees for personal injury or property damage. If any portion of this release shall be deemed by a Court of competent jurisdiction to be invalid, then the remainder of this release shall remain in full force. This release cannot be modified orally.

NOTICE TO THE MINOR CHILDS PARENT OR GUARDIAN:

READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO LET YOUR MINOR CHILD ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY. YOU ARE AGREEING THAT, EVEN IF ACTION ATHLETICS USES REASONABLE CARE IN PROVIDING THIS ACTIVITY, THERE IS A CHANCE YOUR CHILD MAY BE SERIOUSLY INJURED OR KILLED BY PARTICIPATING IN THIS ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM YOU ARE GIVING UP YOUR CHILDS RIGHT AND YOUR RIGHT TO RECOVER FROM ACTION ATHLETICS, STAGE 4 DESIGNS, AND THE BERNARDI FAMILY TRUST IN A LAWSUIT FOR ANY PERSONAL INJURY, INCLUDING DEATH, TO YOUR CHILD OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A NATURAL PART OF THIS ACTIVITY. YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM, AND ACTION ATHLETICS HAS THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN THIS FORM.

ACTION ATHLETICS COVID-19 ACKNOWLEDGEMENTS

I further acknowledge, understand, and agree that I am voluntarily allowing my child to participate in programs and activities offered by Action Athletics knowing that participation may result in possible exposure to and illness from infectious diseases, including, but not limited to, MRSA, Influenza, and COVID-19.  While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist.  I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releases of others, and assume full responsibility for my participation and exposure.  I understand, and agree to allow my child to be spotted when spotting is absolutely necessary.

I further acknowledge that I have reviewed all policies and I understand that failure to follow the rules may result in revocation of all privileges provided by Action Athletics without refund of any prepaid fees. http://www.action-athletics.com

ACTION ATHLETICS COVID-19 Health Evaluation - ONLY VAILD IF SIGNED WITHIN 48 HOURS OF EVENT

In accordance with the Centers for Disease Control (CDC), Action Athletics is screening all participants for certain risk factors before entrance is allowed.  Action Athletics may restrict entry based on responses in order to prevent the spread of COVID-19. Please notify us immediately if there any changes before your event.

Today's Date: October 26, 2021

In the past 14 days, participant has not experienced:

  • A fever above 100.4 degrees
  • Cough, sore throat, congestion, fatigue, or shortness of breath
  • Headache or muscle/joint pain
  • Nausea/vomiting/diarrhea/stomach ache
  • Loss of smell or taste or loss of appetite

I Agree

Participant has not been directed to quarantine due to either testing positive for COVID-19, having a pending COVID-19 test result, or being named as a close contact. 

I Agree

Participant has not been in contact with anyone who has tested positive for COVID-19, or having been in contact with someone who has been sick or had signs or symptoms of COVID-19 (listed above) within the past 14 days. 

I Agree

Participant has not traveled to any country or state currently designated as a high-risk location in the past 14 days. 

I Agree

Participant will submit to and pass a temperature check upon entry. 

I Agree

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Event Date and Time

Please select the date of the party or event you are attending. *
Please select the time of the event you are attending.*
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Event Date and Time

Please select the date of the party or event you are attending. *
Please select the time of the event you are attending.*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Event Date and Time

Please select the date of the party or event you are attending. *
Please select the time of the event you are attending.*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Event Date and Time

Please select the date of the party or event you are attending. *
Please select the time of the event you are attending.*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Event Date and Time

Please select the date of the party or event you are attending. *
Please select the time of the event you are attending.*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Event Date and Time

Please select the date of the party or event you are attending. *
Please select the time of the event you are attending.*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Event Date and Time

Please select the date of the party or event you are attending. *
Please select the time of the event you are attending.*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Event Date and Time

Please select the date of the party or event you are attending. *
Please select the time of the event you are attending.*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Event Date and Time

Please select the date of the party or event you are attending. *
Please select the time of the event you are attending.*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Event Date and Time

Please select the date of the party or event you are attending. *
Please select the time of the event you are attending.*
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*
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*
Parent or Guardian's Event Date and Time

Please select the date of the party or event you are attending. *
Please select the time of the event you are attending.*
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!