Vertical Fusion Liability Waiver

Vertical Fusion LLC is requesting that you sign the Vertical Fusion Liability Waiver. This is a requirement to participate in any part of our program. To decline, please contact the studio at 720-318-1749 for cancellation options. *

Do you consent to signing this legal document electronically? *

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What are your goals? What interested you in trying out our program? *

Do you currently work out regularly and if so, what kind of activity(ies)? *

RELEASE & WAIVER OF LIABILITY, ASSUMPTION OF RISK, & INDEMNITY AGREEMENT

In exchange for permission to participate in Vertical Fusion, LLC dance and fitness programs and/or events, I hereby enter into the following release and waiver of liability assumption or risk and indemnity agreement. I, for myself, my heirs, spouse, executors, administrators, personal representatives, and assignees, waive, release, discharge, indemnify, hold harmless and agree not to sue Vertical Fusion, LLC, its officers, directors, shareholders, employees, agents, landlords, lessees, sponsors, representatives volunteers, affiliates, and franchisees (hereafter the “Released Parties”) from any and all liability, responsibility, damages, losses, claims, demands, actions, suits, judgments, costs and expenses (including attorney’s fees) resulting from personal injury, accidents, illness, death and/or property loss caused in any manner, including the simple, active or passive negligence of the Released Parties, by my participation in the Vertical Fusion, LLC dance and fitness programs and/or events.

PLEASE INITIAL TO CERTIFY THAT YOU HAVE READ AND UNDERSTAND EACH STATEMENT:

Initials* I acknowledge that Vertical Fusion, LLC dance and fitness programs and/or events are designed to stress the heart, lungs, cardiovascular and circulatory systems, muscles, joints, ligaments and tendons in an attempt to improve muscular strength, flexibility, and cardiovascular health.

Initials* I acknowledge that some medical conditions, injuries, and illnesses may create unsafe and seriously harmful circumstances for myself and those training me and I agree to not participate unless I have approval from a medical professional. I agree to notify Vertical Fusion staff members of any old, new, or existing injuries or medical/physical conditions.

Initials* I acknowledge the following are possible contraindications of aerial dance and pole dance and that I should consult with my physician before participating:

Spinal Injuries
Recent joint, bone, or muscle injuries
Pregnancy
Glaucoma
Recent Surgery
Heart Disease
Very High or Very Low Blood Pressure
Vertigo
Seizure Disorders
Osteoporosis or Bone Weakness
Recent Concussion or Head Injury
Hiatal Hernia or Disc Herniation
Recent Stroke
Artificial or Re-Surfaced Hips
Botox (within 24 hours of class)
Any condition that prevents you from inverting or having pressure on your skin

Initials* I certify that I have been advised to consult with my physician with respect to any past, present, or future injury, illness, cardiovascular problem, joint problem or any other condition or medication that may affect my participation and ability to participate in and to endure any exercise programs, and knowingly assume all risks relating to my participation in the Vertical Fusion dance and fitness programs and/or events.

Initials* I acknowledge that I am personally financially responsible for any medical or other treatment needed as a result of my participation in the Vertical Fusion LLC dance and fitness programs and/or events.

Initials* I understand that the Vertical Fusion, LLC staff are not qualified to teach prenatal fitness/movement and therefore, I agree to not participate in Vertical Fusion programs while pregnant.

Initials* I understand that Vertical Fusion, LLC programs are designed for individuals 18 years and older.

Initials* I certify that I am 18 years old or older. (Minors must contact the studio to schedule a parental consultation and approval to participate.)

Initials* I understand that it is strictly against Vertical Fusion LLC’s policy to participate in any activity while impaired or under the influence of any substances.

Initials* I acknowledge that I may be photographed or recorded while on the Vertical Fusion LLC premises. I understand that if I do not want to be recorded, that I will be aware of my surroundings and avoid exposure when my peers or staff members are using recording devices. Likewise, I will do my best to respect others when using a device myself.

I knowingly execute this agreement freely and voluntarily and intend this to be a complete and unconditional release of all liability to the greatest extent allowed by law. I certify that I have read this agreement, fully understand its terms, and understand that I am giving up substantial rights, including my right to sue. This agreement is intended to be as broad and inclusive as permitted by law. If any portion of this agreement is held invalid, the remaining portions will continue in full force and effect.

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Date *

Date

A copy of your submission will be emailed to you via the email address you provided. A copy of this signed document may be downloaded from your secure and personal profile in our MindBody© system under "My Info>Documents".