Informed Consent and Liability Waiver Release for
Participating in SuperABLE Fitness and Exercise Program
I agree and consent to the following:
I am voluntarily participating in the SuperAble Fitness and Exercise Program conducted by The Arc Northwest Mississippi. I recognize that the program requires physical exertion that may be strenuous at times and may cause physical injury and I am fully aware of the risks and hazards involved.
I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the above mentioned program. I represent and warrant that I have no medical condition that would prevent my participation in the program.
I agree to assume full responsibility for any risks, injuries or damage know or unknown which I might incur as a result of participating in the program. Such injuries may include, but are not limited to, heart attacks, muscle strains, muscle pulls, muscle tears, broken bones, shin splints, heat prostration, injuries to knees, injuries to back, injuries to foot, or any other illness or soreness, including death.
I knowingly, voluntarily and expressly waive any claim I may have against The Arc Northwest Mississippi, XPress Fitness, Eric Cook, Longview Heights Baptist Church, Sponsors, Agents, Employees, Volunteers, or instructors for injury or damages that I may sustain as a result of participating in the program.
I, my heirs or representatives forever release waive, discharge and covenant not to sue The Arc Northwest Mississippi, XPress Fitness, Eric Cook, Longview Heights Baptist Church, Sponsors, Agents, Employees, Volunteers, or Instructors for any injury or death caused by their negligence or other acts.