• INSURANCE MEMBERSHIP

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    Silver Sneakers

    Silver & Fit

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    Prime Fitness

  • MEMBER INFORMATION

    Primary account contact.
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  • EMAIL ADDRESS

    By providing your email address, you will receive news letters and occasional updates from the Excelsior Springs Community Center.
  • RESIDENCE ADDRESS

  • EMERGENCY CONTACT INFORMATION

  • ACKNOWLEDGEMENTS

  • WAIVER AND RELEASE OF LIABILITY

    All members are urged to obtain a physicalexamination from a doctor before using pools, exercise equipment orparticipating in any exercise class or program on their own or led by anExcelsior Springs Community Center employee. All exercise, including the use ofthe pool, weights and any and all equipment, and apparatus designed forexercising, shall be at the member's sole risk. All members understand that thedecision to use this facility, or the selection of exercise programs, methodsand types of equipment or pool shall be member's entire responsibility, andExcelsior Springs Community Center shall not be liable to member for anyclaims, demands, injuries, damages or actions arising due to injury to member'sor families’ person or property arising out of or in connection with the use bymember or family of the services, facilities, and premises of Excelsior SpringsCommunity Center. The member and their family hereby holds Excelsior SpringsCommunity Center, its officers, agents and employees harmless from all claimswhich may be brought against them by the member or their family or on member'sbehalf for any such injuries or claims. Donot sign this agreement before reading it and blank spaces are filled in. Themember acknowledges that member has read front and back pages and received acompleted copy of this agreement in compliance with federal and state law.
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  • Tivity Waiver and Assumption of Risk

  • Please consult with your physician before beginning any exercise program.

    I acknowledge that I have voluntarily chosen to participate in one or more physical exercise or fitness activity or sport programs (the “Programs”). I acknowledge (i) the nature of the risks of the particular Programs in which I have chosen to participate, and (ii) the strenuous nature of those Programs. I understand, for example, the risks associated with physical injury, abnormal blood pressure, heart attack and even death; as well as the risks associated with the negligence of a Tivity Health Services, LLC participating location and any other organization or individual participating or involved in providing or promoting any classes, functions, Programs, testing, or other activities that I participate in as a Tivity HealthTM Program member (including without limitation the owners, officers, directors, employees, and representatives of any of the foregoing).

    By signing this document, I expressly assume all risk for my health and well-being and expressly assume the other risks associated with participating in the Programs, including, but not limited to, the negligence of a Tivity Health participating location and any other organization or individual participating or involved in providing or promoting any classes, functions, Programs, testing, or other activities that I participate in as a Tivity Health Program member (including without limitation the owners, officers, directors, employees, and representatives of the foregoing). I also hereby release, waive, discharge and covenant not to sue any class instructor, any Tivity Health participating location, any sponsoring organization, Tivity Health, Inc., or any of their subsidiaries or any other organization or individual providing or promoting classes, functions, Programs, testing, or other activities that I participated in as a Tivity Health Program member (including without limitation the owners, officers, directors, employees, and representatives of any of the foregoing) at any time hereafter, from any and all demands, liabilities, losses, or damages (including death, bodily injury or damage to property) caused or alleged to be caused in whole or in part by the negligence of any of the foregoing people or entities. In addition, I agree that Tivity Health may engage in – and I hereby expressly consent to – (i) the recording (in video and/or still photo format) of my participation in Tivity Health classes, workshops or other programs, and (ii) the publication or other use by Tivity Health of any such recordings in social media, broadcast media, print media, general advertising and similar purposes.

    I have read and understand this waiver and express assumption of risk. I have also read, understand, and will adhere to all guidelines and policies in regard to this benefit. This waiver and release shall survive the term of any agreement with a Tivity Health participating location or individual.

    In the event that my physician has recommended any limitations to my physical activity or I have experienced any of the following conditions, I hereby attest that I have informed my physician of the condition(s) and have obtained express consent from my physician to participate in the Programs.

    • Chest pains while at rest and/or during exertion, previous heart attack or high blood pressure

    • Any heart or circulatory conditions, such as vascular disease, stroke, chest pain, congestive heart failure, poor circulation to the legs, valvular heart disease, blood clots

    • Frequent fast, irregular heartbeats OR very slow heartbeats

    • Diabetes • Previous hip or spinal fracture (as an adult)

    • Lung disease or shortness of breath after mild exertion, at rest, or in bed

    • Open cuts on my feet that do not seem to heal

    • An unexplained weight loss of ten (10) pounds or more in the past six (6) months

    • More than two falls in the past year (no matter what the reason)

    • More than one year since I have engaged in regular physical activity

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  • SUMMARY

  • I have read the waiver and release of liability and authorize applicable payment. All sales are final.
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