Loading...

Using weights and other workout equipment can be an inherently dangerous activity and, as such, Austin17House requires all those participating in such activities or using any Austin17House equipment or facilities to sign this waiver. Participant must be thirteen years of age at minimum to use workout equipment at Austin17House. 


RELEASE AND WAITER OF RESPONSIBILITY

I understand that using workout equipment is an inherently dangerous activity and acknowledge that there are risks inherent in its practice, including but not limited to exposure to sharp objects, exposure to falling objects, or risk of falling. 

I certify that I am 13 years of age or older

I Agree

I understand that my negligence or failure to act within my abilities may contribute to or result in an injury.

I Agree

AUSTIN17HOUSE ("A17H") hereby specifically disclaims any and all responsibility or liability for, and I hereby irrevocably release A17H from, any and all claims, whether known or unknown, which I may have relating to: (i) any and all damages to the student or any personal property of the student, including without limitation, indirect and consequential damages or injuries as a direct or indirect result of the inherent risks of metal working; (ii) any liability relating to instruction, construction, design, use of any A17H equipment or facilities, manufacture of any product, or any other activity undertaken in conjunction with classes, workshops or seminars offered by A17H or as a result of the use or application of information given or contained in any class, workshop or seminar offered by A17H or contained in any writing given to me by A17H or (iii) any actions taken by me while on the A17H premises with respect to construction, design, use of equipment or facilities or manufacture of any product.

I Agree

I hereby represent and warrant that I understand that by signing this document, I may be waiving certain legal rights. I understand that I will be responsible for all actions taken at the A17H facilities, including without limitation, use of equipment and facilities. I

understand that I am solely responsible for any and all damages, whether direct or consequential, for the use and application of

information given at any seminar, workshop or class or contained in any writing distributed by A17H.

May 4, 2024



 

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

First Name*

Last 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.


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.
Parent or Guardian's Name

First Name*

Last Name*

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