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I acknowledge that I am physically sound and suffer from no condition, impairment, disease, infirmity or other illness that would prevent my participation or use of equipment or machinery except as hereinafter stated. I do hereby acknowledge that I have been informed of the need for a physician’s approval for my participation in an exercise or fitness activity or in the use of exercise equipment and machinery. I also acknowledge that it has been recommended that I have a yearly or more frequent physical examination and consultation with my physician as to physical activity, exercise, and use of exercise and training equipment so that I might have his or her recommendations concerning these fitness activities and equipment use. I acknowledge that I have either a physical examination and been given my physicians permission to participate, or that I have decided to participate in activity and use of equipment and machinery with the approval of my physician. Finally, I acknowledge that my participation is completely voluntary and the potential benefits involved in the physical exercise and training fitness program outweigh the potential risks.
Client Responsibilities and PHYSICAL ACTIVITY READINESS QUESTIONAIRE - (PAR-Q)
I understand that it is my sole responsibility to fully disclose any health issues that are relevant to participation in an exercise and fitness training program. I further understand that it is my responsibility to inform my trainer if there are activities that I do not feel comfortable participating and will stop exercise immediately if I experience any unusual discomfort. Finally, I understand that it is my responsibility to clear my participation in the exercise and fitness training program with my physician before participating in the program.
Napa Valley Adventure Boot Camp has requested the above information for informational purposes only. We do not purport to render medical advice to client. If you have questions about the appropriateness of any activity or program, in light of your medical history, please contact your physician.
Waiver of Liability, Indemnity Agreement and Assumption of Risk
Waiver of Liability: I,
for myself, my heirs, personal representatives and assigns in consideration of authorization to use, today and on all future dates, the property, facilities, and services of Jeffrey D. Larson, Jr. Enterprises, Inc., (hereinafter referred to as JDLE), in addition to the payment of any fee or charge, do hereby release, waive, covenant not to sue and discharge JDLE, its owners, directors, officers, employees, trainers, contractors, representatives, volunteers, agents and all others from any and all claims, demands and causes of action arising from the ordinary negligence or omission of JDLE or any of the aforementioned parties. This agreement applies to 1) personal injury (including, but not limited to, death, heart attacks, muscle strains, pulls or tears, broken bones, shin splints, heat prostration, knee/lower back/foot injuries, or any other illness, soreness, or injury), however caused, occurring during or after my participation in JDLE exercise programs or activities including, but not limited to, aerobic dance, weight training, stationary bicycling, organized activities, classes, observation, and individual use of, facilities, premises, aerobic-conditioning machinery or equipment; and to 2) any and all claims resulting from damages to, loss of, or theft of property.
Indemnification and Hold Harmless: I also agree to HOLD HARMLESS AND INDEMNIFY JDLE from ordinary negligence and to reimburse them for any expenses incurred as a result of my participation in exercise, training, and fitness activities at JDLE. I further agree to pay all costs and attorneys’ fees incurred by JDLE in investigating and defending a claim or suit if my claim is withdrawn, or to the extent a court or arbitration determines that JDLE is not responsible for the injury or loss.
Assumption of Risks: I understand and am aware that physical activity, including the use of facilities, equipment and machinery, carries with it inherently dangerous risks that cannot be eliminated regardless of the care taken to avoid injuries. These inherently dangerous physical activities involve a risk of injury and even death and I am voluntarily participating in these inherently dangerous activities offered through JDLE with the knowledge of the inherent dangers involved. I fully understand the nature of physical activity at JDLE, the physical demand of activities made possible by JDLE, and I may injure myself as a result of my participation in JDLE exercise and fitness training program. I hereby affirm that my participation at JDLE is voluntary and expressly assume and accept any and all risks of injury or death.
Severability and Venue: The undersigned further expressly agrees that the foregoing waiver of liability, indemnity, and assumption of risks agreement is intended to be as broad and inclusive as is permitted by the law of the State of CA and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. Likewise, I agree that if legal action is brought, it must be brought in Napa County, CA.
Acknowledgement of Understanding: I have read this waiver of liability, indemnification and assumption of risks agreement and fully understand its terms. I understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing the agreement freely and voluntarily, and intend my signature to be a complete and unconditional release of all liability and assumption of the inherent risks of participating in or observing recreational, fitness, and training activities at JDLE to the greatest extent allowed by law in the State of CA. |
