RyzAb0ve Fitness Participation Waiver

RyzAbOve Fitness

Waiver and Release of Liability

This agreement must be read and signed for you/your child to be eligible to participate in any of our classes, camps, or activities.

Participant's Name: *

First NameLast Name

Date of Birth*

Date

Valid Email Address:*

example@example.com

Has the Participant been fully vaccinated?*

Yes, he/she is fully vaccinated.No, he/she has not been vaccinated.

We currently serve Charlotte and the surrounding areas. Which area are you closest to?*

Verbal Skills*

Full Verbal SkillsLimited Verbal SkillsNonverbal

Which of our class(es) are you currently interested in?*

Freedom Park (Tuesdays & Thursdays)Park Road Park (Saturdays)Brace YMCA (Saturdays @1pm)

PARTICIPATION CONSENT

Please use this space to disclose any known injuries, limitations, and conditions that we should be aware of prior to participation in fitness, social, or other activities hosted by RyzAb0ve Fitness and it's affiliates. Please specify where needed. Type "N/A" if none apply. *

Which of these options is the best way for you to pay for class sessions? Classes are $20 per session or $170 for a 10 class pass. Scholarship opportunities may be available to families in need.*

I understand and certify that my/my child's participation in RyzAb0ve Fitness and its activities is completely voluntary. I have familiarized myself with RyzAb0ve Fitness program and activities in which l/my child will be participating. I recognize that certain hazards and dangers are inherent in these activities, which may include, but not limited to, the activities of high and low elements of ropes course, sports, ect. I acknowledge that although RyzAb0ve Fitness has taken safety measures to minimize the risk of injury to all participants, RyzAb0ve Fitness cannot ensure or guarantee that the participants, equipment, premises or activities will be free of hazards, accidents or injuries. I recognize and have instructed my child in the importance of knowing and abiding by the rules, regulations, and procedures for RyzAb0ve Fitness. Further, I attest that my health insurance will cover any medical and hospital expenses that l/my child incur and I have received approval from a doctor authorizing me/my child to participate in the services offered by RyzAb0ve Fitness. I also agree to inform RyzAb0ve Fitness of any activities in which I/my child may not participate. I understand and agree that my child will be in an environment that involves elements related to nature, camping or community living, such as insects and insect bites, sun exposure, or communicable illness.

MEDICAL AUTHORIZATION/CONSENT TO TREAT

I hereby authorize and give permission to RyzAb0ve Fitness or medical personnel to assess and administer treatment to the camper named above in case of accident, illness, or injury that may arise while said participant is at any of our classes, events or camps. I hereby consent to transport of participant to a health care facility if deemed necessary. In addition, I allow medical personnel to transport the above named participant by motor vehicle, including those owned by RyzAb0ve Fitness and its staff members. RyzAb0ve Fitness and it's staff take the upmost precaution to transport clients safely and will not be held liable individually or collectively for any physical or mental injuries, which may be sustained through motor vehicle transportation to or from RyzAb0ve locations. I consent to any x-ray, scans, medical and/or surgical treatment, as well as hospitalization, as deemed necessary by a licensed health care provider during the participant's session. I understand that this authorization is given in advance of any specific diagnosis, treatment or hospital care, and that it is given to provide the RyzAb0ve Fitness staff authority to seek medical treatment, and to provide a licensed health care provider the authority to administer this treatment as he or she judges necessary to the above-named camper. I accept responsibility for payment of all services rendered (personally or through my insurance carrier); I authorize any medical facility that renders services to release medical information necessary for the processing of insurance claims. I understand that the RyzAb0ve Fitness staff will make a good faith effort to contact me or the provided Emergency Contact (see Application/Health Form) before seeking treatment. If this is not possible, I understand that RyzAb0ve Fitness staff will notify me or my designee as soon as possible of any and all diagnoses and treatments. I also authorize the release of any/all medical information and documents to/from the RyzAb0ve Fitness by my doctor's office(s) in the event further information/clarification are needed.

I AM VOLUNTARILY PARTICIPATING IN THE AFOREMENTIONED ACTIVITY AND I AM PARTICIPATING IN THE ACTIVITY ENTIRELY AT MY OWN RISK. I AM AWARE OF THE RISKS ASSOCIATED WITH PARTICIPATING IN THIS ACTIVITY, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO: PHYSICAL OR PSYCHOLOGICAL INJURY, PAIN, SUFFERING, ILLNESS, DISFIGUREMENT, TEMPORARY OR PERMANENT
DISABILITY (INCLUDING PARALYSIS), ECONOMIC OR EMOTIONAL LOSS, AND DEATH. I UNDERSTAND THAT THESE INJURIES OR OUTCOMES MAY ARISE FROM MY OWN OR OTHERS' NEGLIGENCE, CONDITIONS RELATED TO TRAVEL TO AND FROM THE ACTIVITY, OR FROM CONDITIONS AT THE ACTIVITY LOCATION(S). NONETHELESS, I ASSUME ALL RELATED RISKS, BOTH KNOWN AND UNKNOWN TO ME, OF MY PARTICIPATION IN THIS ACTIVITY.
I HEREBY, for myself, my heirs, executors, administrators, assigns, or personal representatives (hereinaaer collectively, "Releasor," "I" or "me", which terms shall also include Releasor's parents or guardian if Releasor is under 18 years of age or lacks ability to understand and agree to terms), knowingly and voluntarily enter into this WAIVER AND RELEASE OF LIABILITY and hereby waive any and all rights, claims or causes of action of any kind arising out of my participation in the Activity.
I HEREBY ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS "WAIVER AND RELEASE" AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. I EXPRESSLY AGREE TO RELEASE AND DISCHARGE AND ALL OF ITS AFFILIATES, MANAGERS, MEMBERS, AGENTS, ATTORNEYS, STAFF, VOLUNTEERS, HEIRS, REPRESENTATIVES, PREDECESSORS, SUCCESSORS AND ASSIGNS, FROM ANY AND ALL CLAIMS OR CAUSES OF ACTION AND I AGREE TO VOLUNTARILY GIVE UP OR WAIVE ANY RIGHT THAT I OTHERWISE HAVE TO BRING A LEGAL ACTION AGAINST FOR PERSONAL INJURY OR PROPERTY DAMAGE.
I FURTHER ACKNOWLEDGE that Releasees are not responsible for errors, omissions, acts or
failures to act of any party or entity conducting a specific event or activity on behalf of
Releasees. In the event that I should require medical care or treatment, I authorize to provide all emergency medical care deemed necessary, including but not limited to, first aid, CPR, the use
of AEDs, emergency medical transport, and sharing of medical information with medical
personnel. I further agree to assume all costs involved and agree to be financially responsible
for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance.
THIS WAIVER AND RELEASE OF LIABILITY SHALL REMAIN IN EFFECT FOR THE DURATION OF MY
PARTICIPATION IN THE ACTIVITY, DURING THIS INITIAL AND ALL SUBSEQUENT EVENTS OF
PARTICIPATION.

I give RyzAbOve Fitness the right to take photographs, audio or audio-visual recordings of me/my child to be used in promotional, educational, or fundraising materials including, but not limited to videos, pamphlets and brochures. I understand my/my child's name may be used in connection with these materials. By signing this media release, I agree to these terms.

Type a question*

I agree and grant permissionI do NOT agree. I DO NOT grant permission

Signature*

Clear

Printed Name:*

First NameLast Name

I, THE UNDERSIGNED PARTICIPANT, AFFIRM THAT I AM OF THE AGE OF 18 YEARS OR OLDER,AND THAT I AM FREELY SIGNING THIS AGREEMENT. I CERTIFY THAT I HAVE READ THIS AGREEMENT, THAT I FULLY UNDERSTAND ITS CONTENT AND THAT THIS RELEASE CANNOT BE MODIFIED ORALLY. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND THAT I AM SIGNING IT OF MY OWN FREE WILL.

Participant Name*

First NameLast Name

Participant Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

(Parent/Guardian/Self Signature)*

Clear

*If participant signs for themselves, please sign below to confirm you have assisted the participant and understand what they are agreeing to.

Parent/Guardian Signature (if needed)

Clear

Date*

Date

In the event of an emergency, please contact the following person(s) in the order presented:

Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Relationship to Participant:*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Relationship to Participant:*

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please feel free to type below to leave any other information about the participant (including health concerns, support needed, etc) you feel that may be important for us to know. *

Media Release

Emergency Contact #1

Emergency Contact #2