Loading...

New Client Form & Liability Release Waiver

Please complete this waiver to participate in a class or sign-up for a membership at NXGen Fitness Center.

INFORMED CONSENT:

Although there are distinct benefits to exercise in terms of quality and enjoyment of life, strenuous exercise is not without risk to the musculoskeletal and cardiovascular systems.  Before using the facilities of the Center, you and your physician should decide on the appropriateness of exercise given your known risk factors and current state of health.  If an exercise feels awkward or causes pain, stop and consult your physician.  Pain, discomfort and anxiety have no place in sound fitness activity.  I have read this paragraph and this Agreement and I understand it.  I take full responsibility for maintaining an appropriate exercise program, knowing my risk factors and current state of health.  In consideration for being permitted to use the Center's services and facilities, and to engage in exercise activities, including use of all Center facilities (hereinafter collectively referred to as "exercise activities") I hereby agree as follows:

 

1. I HEREBY  RELEASE AND  DISCHARGE the Center, its directors, officers, agents, employees  and instructors, and all the equipment located at the Center (hereinafter  referred  to collectively as the "Released Parties") from any and  all liability, claims, demands or causes of action that I may hereinafter have for injuries and damages arising out of my participation in exercise activities including, but not limited to, losses CAUSED BY NEGLIGENCE OF THE RELEASED PARTIES.

2.  I further agree that I WILL NOT SUE OR MAKE A CLAIM against the Released Parties for damages or other losses sustained as a result of my participation in exercise activities.

3.   I also agree to INDEMNIFY AND HOLD HARMLESS THE RELEASED PARTIES from all claims, judgments and costs, including attorney's  fees, incurred  with any lawsuit brought as a result of my participation or, in the case of family memberships, my family's participation, in exercise activities, INCLUDING ACTIONS BASED UPON THE NEGLIGENCE OF THE RELEASED PARTIES.

4.   I understand that exercise activities have inherent dangers that no amount of care, caution, instruction or expertise can eliminate.  So I EXPRESSLY AND VOLUNTARILY ASSUME ALL RISK OF DEATH OR PERSONAL INJURY SUSTAINED WHILE PARTICIPATING IN EXERCISE ACTIVITIES WHETHER OR NOT CAUSED BY THE NEGLIGENCE OF THE RELEASED PARTIES.

5.    CLIENT SHALL PAY THE CENTER, ITS DIRECTORS, OFFICERS, AGENTS, EMPLOYEES AND INSTRUCTORS, ITS COSTS AND EXPENSES INCLUDING ATTORNEY'S FEES PAID OR INCURRED IN ENFORCING THE TERMS STATED ABOVE.

6.   I ACKNOWLEDGE THAT I CAREFULLY READ AND INITIALED THESE INFORMED CONSENT PROVISIONS, ACKNOWLEDGE THAT  I FULLY UNDERSTAND THEM AND SIGN THIS AGREEMENT OF MY OWN FREE WILL .  

7. The undersigned accepts responsibility for all property damage caused by themselves or their guests. The Center, in its sole reasonable discretion, shall determine whether any property damages result from ordinary wear and tear. The Center shall not be responsible or liable to members and their guest for property damaged, lost or stolen on Center premises and all personal property of a member is maintained on the Center premises at the sole risk of the member.

8. I consent that the Center is allowed to use pictures and/or video that I may be present in for marketing purposes via print, website, cable tv and social media. YES, I want to receive information and offers from NXGen Fitness Center by automatic-dialed text messaging at the number provided.   I understand I am not required to agree to receive these text messages as a condition of becoming a member or purchasing any property, goods, or services. I understand I can opt out at any time by responding with STOP to any text message.

First Client's Name

First Name*

Middle Name

Last Name*

Phone*
First Client's Date of Birth*
First Client's Signature*
Second Client's Name

First Name*

Middle Name

Last Name*
Second Client's Date of Birth*
Third Client's Name

First Name*

Middle Name

Last Name*
Third Client's Date of Birth*
Fourth Client's Name

First Name*

Middle Name

Last Name*
Fourth Client's Date of Birth*
Fifth Client's Name

First Name*

Middle Name

Last Name*
Fifth Client's Date of Birth*
Sixth Client's Name

First Name*

Middle Name

Last Name*
Sixth Client's Date of Birth*
Seventh Client's Name

First Name*

Middle Name

Last Name*
Seventh Client's Date of Birth*
Eighth Client's Name

First Name*

Middle Name

Last Name*
Eighth Client's Date of Birth*
Ninth Client's Name

First Name*

Middle Name

Last Name*
Ninth Client's Date of Birth*
Tenth Client's Name

First Name*

Middle Name

Last Name*
Tenth Client's Date of Birth*
Client'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*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Optional Services
May we contact you to setup a FREE consult/assessment with a Certified Personal Trainer?*
No
Yes
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*

Relationship*

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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!