All information will be kept strictly confidential and will not be shared without your permission.

Required for anyone taking trips: Walver of Liability Hold Harmless Agreement

Mode of travel: Charter Bus/ Commercial Airline / Senior Center Van or Bus

I, the undersigned participant, am participating in trips originating from the Spanish Fork Senior Center. In consideration of my participation in Senior Center trips, Thereby waive all claims or causes of action against the Spanish Fork Senior Citizens Organization, the City of Spanish Fork, Utah. its auxiliary organizations, and the officers directors, employees and agents of all of them, all of which are collectively hereinafter referred to as the Senior Center, arising out of my participation in the activity and hereby release, hold harmless. and discharge the Senior Center from all liability in connection therewith.

Knowing, understanding and fully appreciating all possible risks, hereby expressly, voluntarily. and willingly assume all risks and dangers associated with my participation in this trip. Some of the risks and dangers are listed below. - understand this list is not exhaustive. Common risks include: Travelto and from home and activity meeting location, food poisoning. theft, car accident. pedestrian accident, tripping slipping falling, etc.

In addition, have obtained or have been advised to obtain personal medical coverage. I agree to use my personal medical insurance as a primary medical coverage payment if accident or injury occurs.

I have read this waiver/release and understand the terms used in it and their legal significance This waiver and release is freely and voluntarily given with the understanding that the right to legal recourse against the Senior Center is, knowingly. given up in return for allowing my participation in the activity. My signature on this document is intended to bind not only myself but also my successors, heirs, representatives, administrators, and assignees.

Required for use of the Fitness Room / Fitness Classes: Waiver and Release

I, the undersigned, intend to use some or all of the fitness equipment in the Spanish Fork Senior Center Fitness Room, located in the Spanish Fork
Senior Center (“The Fitness Room”). I hereby expressly consent to my use of the Fitness Room and acknowledge that such use will necessarily involve
participation in exercise and use of fitness equipment that may by physically demanding and may subject me to stress, anxiety and possible hazards.

In consideration of being allowed such use, I do hereby waive, release and forever discharge the Spanish Fork Senior Citizen’s Organization, Spanish
Fork City and its officers, employees, agents, representatives and all others acting on its behalf from any and all claims or causes of action known or
unknown for any and all injury, illness, damage or loss, including but not limited to, death, that may occur to me or my personal property as a result of
my use in any aspect of the equipment, activities, facilities, programs and services offered in the Fitness Room.

I agree to defend and indemnify the Spanish Fork Senior Citizen’s Organization, Spanish Fork City and its officers, employees, agents, representatives
and all others acting on its behalf for loss or damage, including any that result from claims or lawsuits for personal injury, death, or personal property
damage, relating to my use, or any of my family members’ use, of the Fitness Room.

I understand that each person, including myself, has a different capacity for using fitness equipment and participating in fitness activities and
programs. I agree that my use of the Fitness Room is strictly voluntary and has not been requested or required by the Spanish Fork Senior Citizen’s
Organization and/or Spanish Fork City. I further agree that my use of the Fitness Room is at my own risk and that I assume any and all risk of injury,
illness, damage or loss, including, but not limited to, death, that might result. I also agree to assume all risk of damage, loss or theft to or of any of my
personal property that may occur while using the Fitness Room.

I declare myself to be physically sound and suffering from no condition, impairment, disease, infirmity or other illness that would prevent my safe use
of the Fitness Room. I do hereby assume all responsibility for my use of the Fitness Room and any activities or programs in the Fitness Room.
I further acknowledge and accept the rules and procedures concerning the use of the Fitness Room.

Please review Spanish Fork City’s Privacy Policy Statement before submitting this form.