WOODSHED STRENGTH AND CONDITIONING LLC d/b/a WOODSHED STRENGTH AND CONDITIONING 53 AYER RD UNIT F LITTLETON, MA 01460 978-528-0882 INFO@WOODSHEDSTRENGTH.COM ATHLETE_NAME TODAYS_DATE WAIVER OF LIABILITY BY SIGNING THIS DOCUMENT YOU WILL WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE OR CLAIM COMPENSATION FOLLOWING AN ACCIDENT PLEASE READ CAREFULLY! WOODSHED STRENGTH AND CONDITIONING LLC, D/B/A WOODSHED STRENGTH AND CONDITIONING STRONGLY RECOMMENDS THAT YOU CLEAR YOUR PARTICIPATION IN ANY PROGRAM WITH YOUR PHYSICIAN. THE PROTOCOLS OF THIS PROGRAM WILL INVOLVE YOU IN RELATIVELY HIGH INTENSITY WORKOUTS OR INTENSE BODYWORK AND IT IS IMPORTANT YOU UNDERSTAND THE FOLLOWING: ACKNOWLEDGEMENT OF DANGER:
I will be participating in physical training sessions (1-on-1, semi private, and/or group training) at WOODSHED STRENGTH AND CONDITIONING LLC, D/B/A WOODSHED STRENGTH AND CONDITIONING (collectively known as “Services”). I am fully aware that these Services are of a nature and kind that are extremely strenuous. I recognize and understand these Services are not without varying degrees of risk, which may include, but are not limited to the following: Injury to the musculoskeletal and/or cardio respiratory systems, which can result in serious injury or death, injury or death due to negligence on the part of myself, my training partner, my trainer, or other people around me, injury or death due to improper use or failure of equipment, or injury or death due to a medical condition, whether known or unknown by me
ACCEPTANCE OF RESPONSIBILITY: I willingly assume full responsibility for any and all risks that I am exposing myself to as a result of my participation in any Services in this fitness facility and training program and accept full responsibility for any injury or death that may result from my participation.
ASSUMPTION OF RISK: I hereby certify that I know of no medical problems, other than those already disclosed, that would increase my risk of illness and injury as a result of participation in any Services offered by, or designed by, WOODSHED STRENGTH AND CONDITIONING LLC, D/B/A WOODSHED STRENGTH AND CONDITIONING. I understand there exists the possibility of adverse physical changes during participation in any and all Services. I fully understand that these changes could include abnormal blood pressure, fainting, disorder of heart rhythm, stroke, and in very rare instances, heart attack or even death. I understand that the activities that take place on the Premises may not be supervised and that WOODSHED STRENGTH AND CONDITIONING LLC, D/B/A WOODSHED STRENGTH AND CONDITIONING does not provide medical services. I understand that certain prescribed medications may exacerbate these physiological changes and create an even greater risk of physical damage or death. I VOLUNTARILY AND FREELY ASSUME ALL RISKS AND DANGERS THAT MAY OCCUR PURSUANT TO MY USE OF AND PARTICIPATION OF ACTIVITIES ON THE PREMISES, INCLUDING THE RISK OF INJURY, DEATH, OR PROPERTY DAMAGE.
PHYSICAL CONTACT ACKNOWLEDGEMENT: I understand that the Services may involve physical contact between myself, other participants, and, its owners, agents, officers, principals, employees, independent contractors and volunteers. I give permission to be a tactile correction to my form and position in a professional manner by those representing WOODSHED STRENGTH AND CONDITIONING LLC, D/B/A WOODSHED STRENGTH AND CONDITIONING and recognize that they may have direct contact with me. I acknowledge that it is my responsibility to notify WOODSHED STRENGTH AND CONDITIONING LLC, D/B/A WOODSHED STRENGTH AND CONDITIONING if I am uncomfortable with this physical contact and will work with WOODSHED STRENGTH AND CONDITIONING LLC, D/B/A WOODSHED STRENGTH AND CONDITIONING to determine how I may continue to participate in the Services with no contact.
PUBLICITY RELEASE: For good and valuable consideration, the receipt of which is hereby acknowledged, I hereby irrevocably grant to WOODSHED STRENGTH AND CONDITIONING LLC, D/B/A WOODSHED STRENGTH AND CONDITIONING, the irrevocable, perpetual and unrestricted (except as expressly set forth below) right and permission, to use and publish my appearance (“publicity rights”) in any and all media now or hereafter known in connection with WOODSHED STRENGTH AND CONDITIONING LLC, D/B/A WOODSHED STRENGTH AND CONDITIONING, the Services, including any goods or products, or any related activities to any of the foregoing (all such medium in which the Publicity Rights are used shall be referred to as the “pictures”), for any commercial purpose whatsoever, without royalty, payment, or any other compensation whatsoever to me. For such use of the Publicity Rights and the Pictures, I understand and agree that I will not be entitled to any compensation or consideration beyond my participation in the Services. I further agree that WOODSHED STRENGTH AND CONDITIONING LLC, D/B/A WOODSHED STRENGTH AND CONDITIONING may edit, alter, digitize, synchronize, reproduce or otherwise change the Pictures for any such purpose. I acknowledge that I shall have no, and hereby expressly disclaim, any ownership, authorship or moral rights in the Pictures or any part thereof.
VIDEO SURVEILLANCE: I recognize the need for video surveillance on and about Premises for security and productivity purposes. I recognize and agree that it is a condition of participation at WOODSHED STRENGTH AND CONDITIONING LLC, D/B/A WOODSHED STRENGTH AND CONDITIONING that I freely execute and agree to this video surveillance, including being personally recorded pursuant to said video surveillance. I agree that the Released Parties may use any taping of my image, voice or appearance at any time pursuant to said video surveillance at its discretion in the ordinary course of its operations.
AUDIO/VISUAL PUBLICITY WAIVER: I agree to indemnify and hold harmless the Released Parties, its agents, successors, and assigns, from any and all claims, demands, actions or causes of action, liabilities, costs, dues, sanctions, fees, penalties, or expenses of any sort arising from the making of such recordings of me and their lawful and appropriate use. I further acknowledge that WOODSHED STRENGTH AND CONDITIONING LLC, D/B/A WOODSHED STRENGTH AND CONDITIONING exclusively owns all rights to these recordings regardless of the form in which they are produced or used.
COPYRIGHTS: The rights granted to the Released Parties herein include, without limitation, all rights of every nature whatsoever in connection with use of the Pictures, including without limitation all copyrights (and any other intellectual property rights) therein and renewals and extensions thereof. I acknowledge and agree that all copyrights and right of every other kind relating or pertaining to the Pictures described above are the sole property of WOODSHED STRENGTH AND CONDITIONING LLC, D/B/A WOODSHED STRENGTH AND CONDITIONING and I have no claim to the copyrights (or any other intellectual property rights) in the Pictures.
CHILD OF PARTICIPANT: I willingly assume full responsibility for any and all risks that I am exposing my child/children to as a result of bringing him/her/them with me to this fitness facility and Services and accept full responsibility for any injury or death that may result to them from their presence and/or unauthorized/unsupervised action and activity. I hereby certify that I know of no medical problems that would increase his/her/their risk of illness, injury, or death as a result of his/her/their presence in the fitness facility. I willingly assume full responsibility of supervision of my child/children during my entire time at WOODSHED STRENGTH AND CONDITIONING LLC, D/B/A WOODSHED STRENGTH AND CONDITIONING With my full understanding of the above information, I agree to assume any and all risks to my child/children associated with my participation in any and all Services at this fitness facility.
SERVICE ANIMAL: I understand that only certified service animals are permitted at WOODSHED STRENGTH AND CONDITIONING LLC, D/B/A WOODSHED STRENGTH AND CONDITIONING. A "certified service animal" is defined as the following: a hearing animal, guide animal, assistance animal, seizure alert animal, mobility animal, psychiatric service animal, or autism service animal. Certified service animals must comply with all licensing, vaccination, behavior and conduct requirements. I understand that I am required to notify WOODSHED STRENGTH AND CONDITIONING LLC, D/B/A WOODSHED STRENGTH AND CONDITIONING prior to bringing my service animal with me to the fitness facility. I shall be strictly liable for any damage or injury to any person or property caused by such animal. I will indemnify, defend, and hold harmless WOODSHED STRENGTH AND CONDITIONING LLC, D/B/A WOODSHED STRENGTH AND CONDITIONING, and its owners, agents, officers, principals, employees, independent contractors and volunteers for any damages, loss, expenses, attorneys' fees, costs, judgments or liability which might accrue as the case may be, because of the presence of such animal in the fitness facility, regardless of whether the animal's presence is permitted.
WAIVER: In full consideration of the above mentioned risks and hazards and in full consideration of the fact that I am willingly and voluntarily participating in the Services made available by WOODSHED STRENGTH AND CONDITIONING LLC, D/B/A WOODSHED STRENGTH AND CONDITIONING, and with my full understanding of all of the above, I hereby waive, release, remise and discharge WOODSHED STRENGTH AND CONDITIONING LLC, D/B/A WOODSHED STRENGTH AND CONDITIONING, and its owners, agents, officers, principals, employees, independent contractors and volunteers (the “Released Parties”), of any and all liability, claims, demands, action or rights of actions, or damages of any kind related to, arising from, or in any way connected with, my participation in the offered Services at WOODSHED STRENGTH AND CONDITIONING LLC, D/B/A WOODSHED STRENGTH AND CONDITIONING.
CONSENT TO MEDICAL TREATMENT: In connection with any injury that I may sustain or illness or other medical conditions that I may experience during my presence at WOODSHED STRENGTH AND CONDITIONING LLC, D/B/A WOODSHED STRENGTH AND CONDITIONING, I authorize and consent to receive any emergency first aid, medication, medical and/or surgical treatment deemed necessary by the attending personnel and/or the Released Parties. I acknowledge that the Released Parties are under no obligation to provide such medical treatment or services, and the Released Parties do not warrant or make any representation concerning the adequacy or continuation of such medical services, nor can the Released Parties be deemed responsible or held liable for any claims arising out of the provision of such medical services or the failure to provide or to continue to provide such medical services. I further authorize the Released Parties to execute on my behalf any permission forms, consents or other appropriate documents relating to medical attention and to act on my behalf if not able or immediately available to do so and the same is urgent as determined in their sole discretion.
I ACKNOWLEDGE AND AGREE THAT EMERGENCY ASSISTANCE AND/OR TREATMENT MAY BE RENDERED BY PERSONS WITH TRAINING OR EXPERIENCE WHICH MAY NOT BE ADEQUATE FOR CERTAIN MEDICAL SITUATIONS AND/OR THE INJURIES SUSTAINED BY ME, WHICH INJURIES MAY BE COMPOUNDED BY NEGLIGENT FIRST AID OR EMERGENCY RESPONSE OF THE RELEASED PARTIES OR OTHER INDIVIDUALS OR MEDICAL OR EMERGENCY PERSONNEL AND WAIVE ANY CLAIM IN RESPECT THEREOF. I expressly acknowledge that if WOODSHED STRENGTH AND CONDITIONING LLC, D/B/A WOODSHED STRENGTH AND CONDITIONING is located some distance from medical facilities, that such distance may exacerbate any injury or condition sustained by me. I shall be responsible for all costs associated with such medical care and related transportation.
PERSONAL PROPERTY: I am responsible for the security and safety of my own property and any personal effects I use, bring to or leave at the Premises, and that the Released Parties cannot guarantee the security or safety of my property. Should I leave any property at the Premises or otherwise in the custody of the Released Parties, I do so at my sole and absolute risk. None of the Released Parties shall have any liability to me or anyone else in the event of loss, damage, destruction or use, whether authorized or not, by any person or theft of any such property.
COVENANT NOT TO SUE: I agree, for myself and all my heirs, not to sue the Released Parties or initiate or assist in the prosecution of any claim for damages or cause of action against the Released Parties which I or my heirs may have as a result of any personal injury, death or property damage I may sustain while on or using the Premises. If a parent or guardians is signing on behalf of me as a minor child, he/she is giving permission to administer the necessary first aid, and in case of serious illness or injury, he/she is giving permission to call for medical and or surgical care for the child and to transport the child to a medical facility deemed necessary for the well-being of the child. INDEMNIFICATION: I recognize there is risk involved in the types of Services offered at WOODSHED STRENGTH AND CONDITIONING LLC, D/B/A WOODSHED STRENGTH AND CONDITIONING. Therefore, I accept financial responsibility for any injury or death that I, or the participant, may cause either to myself/him/herself or to any other participant due to my/his/her negligence. Should the above mentioned parties, or anyone acting on their behalf, be required to incur reasonable attorney’s fees or costs to enforce this agreement, I agree to reimburse them for such fees and costs. I further agree to indemnify and hold harmless WOODSHED STRENGTH AND CONDITIONING LLC, D/B/A WOODSHED STRENGTH AND CONDITIONING, and its owners, agents, officers, principals, employees, independent contractors and volunteers from liability for the injury or death of any person(s) and damage to property that may result from my negligent or act or omission while participating in any and all Services offered at WOODSHED STRENGTH AND CONDITIONING LLC, D/B/A WOODSHED STRENGTH AND CONDITIONING. HOLD HARMLESS: I further agree to indemnify, save and hold WOODSHED STRENGTH AND CONDITIONING LLC, D/B/A WOODSHED STRENGTH AND CONDITIONING harmless from any loss, liability, attorneys’ fees, damage, or costs that it may incur arising out of or related to my participation, or my child/children being in the fitness facility, whether caused by the negligence of WOODSHED STRENGTH AND CONDITIONING LLC, D/B/A WOODSHED STRENGTH AND CONDITIONING or otherwise.
GOVERNING LAW AND VENUE: This Release and Waiver of Liability agreement will be governed by and interpreted in accordance with the laws of the State of Massachusetts, without giving effect to the principles of conflicts of law. I agree that any action arising out of this Release and Waiver of Liability agreement must be brought exclusively in Massachusetts, Middlesex County.
PARENTAL CONSENT: (if applicable) I, the undersigned parent or legal guardian of the minor child, have read the above and understood the foregoing assumption of risk, and release of liability, and agree to its terms on behalf of my child and myself. I understand that by signing below, I am giving up substantial rights on behalf of my child and myself. I have fully read and fully understand the foregoing assumption of risk, and release of liability, and I understand that by signing, it obligates me to indemnify the parties named for any liability for injury or death of any person and damage to property caused by my negligent or intentional act or omission. I understand that by signing this form I am waiving valuable legal rights. I have been provided an opportunity to ask an attorney questions regarding this form and any fitness related program, as well as questions for clarity. By signing, I am verifying that I have received adequate and sufficient answers to all of my questions. /S/ Justin Keane (Signature of Health Club Staff) SIGN HERE: _________________________________________ (Signature of Participant) |