WAIVER AND RELEASE OF
LIABILITY
In
consideration of the risk of injury while participating in Fitness Bootcamp
(the "Activity"), and as consideration for the right to participate
in the Activity, I hereby, for myself, my heirs, executors, administrators,
assigns, or personal representatives, knowingly and voluntarily enter into this
waiver and release of liability and hereby waive any and all rights, claims or
causes of action of any kind whatsoever arising out of my participation in the
Activity, and do hereby release and forever discharge Five Pillar Fitness (Ted
DeConne), located at 100 Stowe Avenue, MILFORD, Connecticut 06461, their affiliates, managers, members, agents,
attorneys, staff, volunteers, heirs, representatives, predecessors, successors
and assigns, for any physical or psychological injury, including but not
limited to illness, paralysis, death, damages, economical or emotional loss,
that I may suffer as a direct result of my participation in the aforementioned
Activity, including traveling to and from an event related to this Activity.
I
am voluntarily participating in the aforementioned Activity and I am
participating in the Activity entirely at my own risk. I am aware of the risks
associated with traveling to and from as well as participating in this
Activity, which may include, but are not limited to, physical or psychological
injury, pain, suffering, illness, disfigurement, temporary or permanent
disability (including paralysis), economic or emotional loss, and death. I
understand that these injuries or outcomes may arise from my own or others'
negligence, conditions related to travel, or the condition of the Activity
location(s). Nonetheless, I assume all related risks, both known or unknown to
me, of my participation in this Activity, including travel to, from and during
this Activity.
I
agree to indemnify and hold harmless Five Pillar Fitness (Ted DeConne) against
any and all claims, suits or actions of any kind whatsoever for liability,
damages, compensation or otherwise brought by me or anyone on my behalf,
including attorney's fees and any related costs, if litigation arises pursuant
to any claims made by me or by anyone else acting on my behalf. If Five Pillar
Fitness (Ted DeConne) incurs any of these types of expenses, I agree to
reimburse Five Pillar Fitness (Ted DeConne).
I
acknowledge that Five Pillar Fitness (Ted DeConne) and their directors,
officers, volunteers, representatives and agents are not responsible for errors,
omissions, acts or failures to act of any party or entity conducting a specific
event or activity on behalf of Five Pillar Fitness (Ted DeConne).
I
acknowledge that this Activity may involve a test of a person's physical and
mental limits and may carry with it the potential for death, serious injury,
and property loss. The risks may include, but are not limited to, those caused
by terrain, facilities, temperature, weather, lack of hydration, condition of
participants, equipment, vehicular traffic and actions of others, including but
not limited to, participants, volunteers, spectators, coaches, event officials
and event monitors, and/or producers of the event.
I acknowledge that I have
carefully read this "waiver and release" and fully understand that it
is a release of liability. I expressly agree to release and discharge Five
Pillar Fitness (Ted DeConne) and all of its affiliates, managers, members,
agents, attorneys, staff, volunteers, heirs, representatives, predecessors,
successors and assigns, from any and all claims or causes of action and I agree
to voluntarily give up or waive any right that I otherwise have to bring a
legal action against Five Pillar Fitness (Ted DeConne) for personal injury or
property damage.
To the extent that
statute or case law does not prohibit releases for negligence, this release is
also for negligence on the part of Five Pillar Fitness (Ted DeConne), its
agents, and employees.
In
the event that I should require medical care or treatment, I agree to be
financially responsible for any costs incurred as a result of such treatment. I
am aware and understand that I should carry my own health insurance.
In
the event that any damage to equipment or facilities occurs as a result of my
or my family's willful actions, neglect or recklessness, I acknowledge and
agree to be held liable for any and all costs associated with any actions of
neglect or recklessness.
This Agreement was entered into at arm's-length, without
duress or coercion, and is to be interpreted as an agreement between two
parties of equal bargaining strength. Both the Participant,
__________________________, and Five Pillar Fitness (Ted
DeConne) agree that this Agreement is clear and
unambiguous as to its terms, and that no other evidence will be used or admitted
to alter or explain the terms of this Agreement, but that it will be
interpreted based on the language in accordance with the purposes for which it
is entered into.
In
the event that any provision contained within this Release of Liability shall
be deemed to be severable or invalid, or if any term, condition, phrase or
portion of this agreement shall be determined to be unlawful or otherwise
unenforceable, the remainder of this agreement shall remain in full force and
effect, so long as the clause severed does not affect the intent of the
parties. If a court should find that any provision of this agreement to be
invalid or unenforceable, but that by limiting said provision it would become
valid and enforceable, then said provision shall be deemed to be written,
construed and enforced as so limited.
In
the event of an emergency, please contact the following person(s) in the order
presented:
Emergency Contact |
Contact
Relationship |
Contact Telephone |
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I, the undersigned
participant, affirm that I am of the age of 18 years or older, and that I am
freely signing this agreement. I certify that I have read this agreement, that
I fully understand its content and that this release cannot be modified orally.
I am aware that this is a release of liability and a contract and that I am
signing it of my own free will.
Participant's Name: |
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Participant's Address: |
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In
the event that the participant is under the age of consent (18 years of age),
then this release must be signed by a parent or guardian, as follows:
I
hereby certify that I am the parent or guardian of
____________________________, named above, and do hereby give my consent
without reservation to the foregoing on behalf of this individual.
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Parent / Guardian Name: |
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Relationship to Minor: |
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Signature: |
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Date: |
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