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200 WEST ADAMS STREET

FITNESS CENTER WAIVER FORM

I, am an employee of TBD, (Tenant) a tenant at 200 West Adams Street, Chicago, Illinois (Building), leasing space known as Suite TBD.

I understand that, so long as Tenant is a lessee of the Building and I am an employee of Tenant, I may use the Fitness Center located on the 17th floor of the Building, subject to the rules, regulations and hours of the Fitness Center. I acknowledge that (i) the Fitness Center is not supervised or staffed, (ii) there are inherent risks to exercising and (iii) I have been advised to obtain a physical examination prior to using the Fitness Center. I certify that I am in good physical condition and able to use the facilities and equipment, and participate in exercises and fitness activities available at the Fitness Center. I represent that I have no disability, impairment, or ailment preventing me from engaging in active or passive exercise or that will be detrimental to my health, safety or physical condition if I do engage in such activities. I voluntarily assume all risks associated with my use of the Fitness Center and understand Landlord is not responsible for theft, loss of personal property or injury including both injury and death. I understand that I need to lock up my personal items in the lockers provided in the locker room and that I will take my items out of the locker room when finished with my workout. I understand all items left in the locker room will be disposed of. 

In consideration for being permitted to use the Fitness Center, I hereby waive, release and discharge 200 West Adams, LLC; BSREF Holdings, LLC ISAOA, ATIMA; and Jones Lang LaSalle Americas (Illinois) LP and all of their respective direct and indirect partners, members, officers, directors, employees, personnel, agents or contractors thereof (each such person and entity individually, and all such persons, and entities collectively, referred to herein and the “Landlord”) from any and all claims and causes of action of any nature whatsoever, including for personal injury, loss, illness, harm, damage, or death, which I or my heirs ever have against Landlord on account of or arising in connection with my presence in or use of the Fitness Center, with my placement of personal property therein, or with Landlord’s proper or improper maintenance of the equipment and fixtures provided therein. 

I further agree to indemnify and hold Landlord harmless from and against any and all loss, cost, damage and expense (including reasonable attorney’s fees and cost) which Landlord may sustain or incur as a result of or in connection with my use of the Fitness Center.

By signing below, I acknowledge that I sign this waiver form voluntarily with the knowledge that I am waiving important legal rights and that I have read and fully understand the Rules and Regulations for the Fitness Center and the above waiver, release, indemnity and hold harmless provisions.

Please make $75.00 check payable to: 200 West Adams, LLC

Date: July 14, 2026

200 West Adams, LLC

200 W. Adams Street, Suite 2001

Chicago, IL 60606

T: 312.407.8000 

First Participant's Name
First Name*
Middle Name
Last Name*
Phone*
Select Gender
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
First Participant's Information
Previous access granted?*
Yes
No
Company Name *
Suite *
Key Card Number: *
Check #
First Participant's Signature*
Second Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Information
Previous access granted?*
Yes
No
Company Name *
Suite *
Key Card Number: *
Check #
Third Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Information
Previous access granted?*
Yes
No
Company Name *
Suite *
Key Card Number: *
Check #
Fourth Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Information
Previous access granted?*
Yes
No
Company Name *
Suite *
Key Card Number: *
Check #
Fifth Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Information
Previous access granted?*
Yes
No
Company Name *
Suite *
Key Card Number: *
Check #
Sixth Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Information
Previous access granted?*
Yes
No
Company Name *
Suite *
Key Card Number: *
Check #
Seventh Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Information
Previous access granted?*
Yes
No
Company Name *
Suite *
Key Card Number: *
Check #
Eighth Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Information
Previous access granted?*
Yes
No
Company Name *
Suite *
Key Card Number: *
Check #
Ninth Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Information
Previous access granted?*
Yes
No
Company Name *
Suite *
Key Card Number: *
Check #
Tenth Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Information
Previous access granted?*
Yes
No
Company Name *
Suite *
Key Card Number: *
Check #
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.
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*
Middle Name
Last Name*
Phone*
Select Gender
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
Parent or Guardian's Information
Previous access granted?*
Yes
No
Company Name *
Suite *
Key Card Number: *
Check #
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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