ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM
PROSPECTIVE TRAINEE MUST READ, ACKNOWLEDGE, AND AGREE TO THE FOLLOWING:
We state: Paris Butler (Bald Omni Man) is not a licensed dietitian or nutritional specialist. All information you obtain will be directly from Paris Butler’s own experiences. It is of best interest for anyone looking to start a new fitness program/powerlifting prep to consult a physician before doing so; it would be wise to have blood work done, and a physical performed by a licensed physician.
Before submitting this application, please read and understand the following: You (customer) to tally understand that you (customer) may injure yourself as a result of participation in a powerlifting meet preparation/general fitness program, and hereby release Paris Butler (Bald Omni Man) from any liability now or in the future for any injury, including, but not limited to heart attacks, death, muscle strains, pulls or tears, broken bones, shin splints, heat prostration, knee/lower back/foot injuries and any other illness, soreness or injury however caused , occurring during or after my participation in the powerlifting meet prep/fitness program offered.
By submitting this application, you state that in consideration of your participation in Paris Butler’s (Bald Omni Man) program, you for yourself, your personal representatives, administrators, heirs and assigns, hereby holds harmless, Paris Butler (Bald Omni Man) from any claims arising from your participation in the fitness program/powerlifting meet prep. By submitting this application, you agree that you have listed all current/past medications and diagnoses, and that you have spoken with your doctor and been cleared to participate in your planned activities
By submitting this application, you agree that you have are being seen by a physician for your current medical diagnoses/medication regiment, and if for any reason you stop seeing your current physician for the above conditions/medications you will inform Paris Butler.
You also affirm that any existing medical diagnoses have been deemed stable enough to undergo the activities described in Paris Butler’s (Bald Omni Man) program.
By submitting this application, you affirm that you have read, have been honest with Paris Butler and also fully understand the above information.
I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES ASSOCIATED WITH THIS EVENT, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault.
I certify that I am physically fit, have sufficiently prepared or trained for participation in this activity, and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in this activity.
I acknowledge that this Accident Waiver and Release of Liability Form will be used by the event holders, sponsors, and organizers of the activity in which I may participate, and that it will govern my actions and responsibilities at said activity.
In consideration of my application and permitting me to participate in this activity, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows:
(A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this activity, THE FOLLOWING ENTITIES OR PERSONS: Paris Butler (Bald Omni Man)
(B) INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise.
I acknowledge that Paris Butler is NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf.
I acknowledge that this activity may involve a test of a person's physical and mental limits and carries with it the potential for death, serious injury, and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of participants, equipment, vehicular traffic, lack of hydration, and actions of other people including, but not limited to, participants, volunteers, monitors, and/or producers of the activity. These risks are not only inherent to participants, but are also present for volunteers.
I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity.
I understand while participating in this activity, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the activity holders, producers, sponsors, organizers, and assigns.
The Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.
I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.
Fees & Terms:
Athlete/Client understands that payments are non-refundable for the coaching services offered. Athlete/Client acknowledges that they have the option to discontinue coaching at any time PROVIDED that the Athlete/Client lets Paris Butler know 30 days in advance before the next 4 week block if they wish to discontinue coaching. Athlete/Client understands and accepts that an unfinished program or training will not be refunded. Athlete/client understands that applicable fees will be incurred with early cancellation (refer to section below for late fees)
Paris Butler may dissolve trainer/trainee relationship at any time for reasons of misconduct, abuse, or other disqualifying factors of similar characterization. In the event of the occurrence of abuse, the client affirms that they understand that a non-refundable $500 fee will be assessed.
Abuse is defined as:
- No call no showing more than once
- Racist, sexist, discriminatory, or other inappropriate conduct or remarks of a similar nature to those described
- Abuse of training equipment
- Threats of physical violence and/or enacting physical violence, or otherwise engaging in harmful behavior of any kind
- Failure to pay on time more than once
- Failure to pay in full more than once
Online Coaching Fees and Terms:
Client understands that coaching is $300 per month before any discounts, with a minimum 3-month commitment.
Client understands that a deposit of $150 is required at the time of signature of this waiver and acceptance, due before the first training day in the block. Client understands that the remaining $150 is due on the date of the first training day, by end of day.
Client understands that if their first session is scheduled before the 15th of the month, their payments thereafter are due on the 1st of the month.
Clients understands that if their first session is scheduled after the 15th of the month, their payments thereafter are due on the 15th of the month.
Client understands that if a payment is late by more than 2 business days, a late fee of $45 will be assessed in addition to the rate for coaching. Every week additional thereafter will incur an additional late fee of $45 per week.
Client understands that if they cancel early before their contract is completed, they will be assessed an early cancellation fee of $400 OR HALF of the combined remainder of the agreed upon training contract, whichever is greater.
Client understands that one-time program templates are $150 and $275 respectively
Confirmation
By signing and submitting this form, I understand and agree that I have received, read, and agreed to the terms mentioned in this form. In doing so, I acknowledge and accept the responsibilities required of me, and I release Paris Butler, and parties affiliated with the company from all liabilities described therein.
BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE