Loading...

WAIVER OF LIABILITY

201 VETERANS RD

YORKTOWN HEIGHTS, NY 10598

INFO@EASTCOASTSPORTSANDFITNESS.COM

Waiver and Medical Release – MUST BE SIGNED UPON REGISTRATION

I hereby warrant and represent that I have no disability, impairment, or ailment preventing me from engaging in active or passive exercise or activity that will be detrimental to my health, safety, or physical condition if I so engage or participate. This representation is made by the undersigned knowing that EAST COAST SPORTS & FITNESS CORP (the “club”) will rely on the same. The undersigned hereby acknowledges that in using the facilities, programs and equipment of the club I do so entirely at my own risk. In consideration of my ability to use the club’s facilities and equipment I expressly agree that the club shall not be liable for any personal injuries or any loss or damage to property sustained on or about the club premises resulting from or arising out of the negligence of the club and/or its staff, or the negligence of any other person on the premises of the club and I assume full responsibility for same. I affirm that there are inherent risks in all health and fitness club activities that I am aware of and appreciate these risks and I assume all responsibility for personal injury and/or loss from these injuries.

I understand that the participant may be photographed during a program and that the photo may be used for promotional materials.

I further agree to release from liability and to Indemnity and hold harmless the club for any and all claims arising as a result of my engaging in club activities or any activities incidental thereto, wherever, whenever, or however the same may occur.

I affirm that I am of legal age and am freely signing this agreement, or that I am the parent or legal guardian of the minor for whom I am giving up legal rights and/or remedies which may be available to me for ordinary negligence of the club.

I hereby grant East Coast Sports and Fitness Corp permission to use the above named person my likeness in a photograph, video or other digital media (photo) in any and all of its publications, including web-based publications, social media, website and other promotional media without payment or other consideration.

Today's Date: May 26, 2024

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Are you a member of East Coast Sports & Fitness (formerly Solaris)?
Gender
M
F
Other

Age:

Rental Date:
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

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

Are you a member of East Coast Sports & Fitness (formerly Solaris)?
Gender
M
F
Other

Age:

Rental Date:
Third Participant's Name

First Name*

Middle Name

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

Are you a member of East Coast Sports & Fitness (formerly Solaris)?
Gender
M
F
Other

Age:

Rental Date:
Fourth Participant's Name

First Name*

Middle Name

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

Are you a member of East Coast Sports & Fitness (formerly Solaris)?
Gender
M
F
Other

Age:

Rental Date:
Fifth Participant's Name

First Name*

Middle Name

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

Are you a member of East Coast Sports & Fitness (formerly Solaris)?
Gender
M
F
Other

Age:

Rental Date:
Sixth Participant's Name

First Name*

Middle Name

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

Are you a member of East Coast Sports & Fitness (formerly Solaris)?
Gender
M
F
Other

Age:

Rental Date:
Seventh Participant's Name

First Name*

Middle Name

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

Are you a member of East Coast Sports & Fitness (formerly Solaris)?
Gender
M
F
Other

Age:

Rental Date:
Eighth Participant's Name

First Name*

Middle Name

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

Are you a member of East Coast Sports & Fitness (formerly Solaris)?
Gender
M
F
Other

Age:

Rental Date:
Ninth Participant's Name

First Name*

Middle Name

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

Are you a member of East Coast Sports & Fitness (formerly Solaris)?
Gender
M
F
Other

Age:

Rental Date:
Tenth Participant's Name

First Name*

Middle Name

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

Are you a member of East Coast Sports & Fitness (formerly Solaris)?
Gender
M
F
Other

Age:

Rental Date:
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
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:*
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*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Are you a member of East Coast Sports & Fitness (formerly Solaris)?
Gender
M
F
Other

Age:

Rental Date:
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!