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Acknowledgement, Waiver & Release from Liability Agreement

PARTICIPANT AGREEMENT, RELEASE AND ASSUMPTION OF RISK In consideration of the services of Life Shop, their agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf (Hereinafter collectively referred to as Life Shop), I hereby agree to release, indemnify, and discharge Life Shop, on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representative and estate as follows:

1. I acknowledge that my participation in physical activities, and other fitness or amusement activities entails known and unanticipated risks that could result in physical or emotional injury, paralysis, death, or damage to myself, to property, or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity. The risks include, among other things: slips and falls; falling from equipment; rope burns; pinches, scrapes, twists and jolts that could result in scratches, bruises, sprains, lacerations, fractures, concussions, or even more severe life threatening hazards; strains, cuts, bruises, muscle soreness and fractures; musculoskeletal injuries including head, neck and back; injuries to internal organs; the negligence of other people; my own physical condition, and the physical exertion associated with this activity. Furthermore, Life Shop employees have difficult jobs to perform. They seek safety, but they are not infallible. They might be unaware of a participant’s fitness or abilities. They might misjudge the weather or other environmental conditions. They may give incomplete warnings or instructions, and the equipment being used might malfunction.

2. I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks.

3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Life Shop from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of Life Shops equipment or facilities, including any such claims which allege negligent acts or omissions of Life Shop.

4. Should Life Shop, or anyone acting on their behalf, be required to incur attorney’s fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.

5. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. I further certify that I am willing to assume the risk of any medical or physical condition I may have.

6. Group Therapy is a unique kind of therapy where a group of people who are likely experiencing similar challenges in the period of their lives gets together to share their difficulties which as a result give and at the same time, receive help from each other. We make sure to maintain a safe environment that is conducive both for sharing and accepting each other where each can grow and trust one another and where each and every one will feel respected and valued.

We respect each and everyone's right to privacy and confidentiality and we shall make sure to maintain it that way. However, please understand that this is not absolute and is limited to provide for by law. Certain limitations are as follows:

  • Threatening one's self or another that may result in physical harm;
  • An act of physical or emotional abuse against a child or any person;
  • Sexual abuse against a child where the child is living with the abuser;
  • Your prior written consent to release records.
  • For the safety it is necessary that the following is required to be complied with by its members:

• Discussions made within the group session are not allowed to be discussed outside with anyone and should maintain the practice of confidentiality in order to build trust with fellow members;

  • Members should maintain positivity and not induce disrespect among others;
  • Maintain conduct that brings respect to fellow members' thoughts
  • I agree to adhere to the norms and expectations for group therapy as indicated above.

7. In the event that I file a lawsuit against Life Shop, I agree to do so solely in the state of Utah, and I further agree that the substantive law of that state shall apply in that action without regard to the conflict of law rules of that state. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining document shall remain in full force and effect.

8. Assumption of the Risk andWaiverof Liability Relating to Coronavirus/COVID-19. The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. Life Shop of Lehi, Utah has put in place preventative measures to reduce the spread of COVID-19; however, Life Shop cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending Life Shop could increase your risk and your child(ren)’s risk of contracting COVID-19. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending the Gym and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at Life Shop may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Life Shop employees, volunteers, and program participants and their families.

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at Life Shop or participation in Life Shop programming (“Claims”).

On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless Life Shop, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Club, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Club program.

I,

 the parent or legal guardian of
grant Life Shop my permission to use the photographs and videos taken for promotional purposes for any legal use, including but not limited to: publicity, copyright purposes, illustration, advertising, and web content.

By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against Life Shop on the basis of any claim from which I have released them herein. I have read and understand the rules of Life Shop (either viewed on the website or at the facility). I have had sufficient opportunity to read this entire document. I have read and understood it and I agree to be bound by its terms.

FOR MINORS: In consideration of 'Minor being permitted by Life Shop to participate in its activities and to use its equipment and facilities, I further agree to indemnify and hold harmless Life Shop from any and all claims which are brought by, or on behalf of Minor, and which are in any way connected with such use or participation by Minor.

IF SIGNING FOR MINORS: You may only sign for minors if you are the parent or legal (court appointed) guardian.

IF SIGNING FOR SELF: You must be at least 18 years old.


First Participant's Name
First Name*
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Second Participant's Signature*
Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Signature*
Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Signature*
Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Signature*
Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Signature*
Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Signature*
Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Signature*
Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Signature*
Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Signature*
Parent or Guardian's Email Address
Email*
Confirm Email*

PARENTS/GUARDIANS: You must sign for minors if you are the parent or legal (court appointed) guardian of the participant.  




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 Date of Birth*
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.


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