Full Name*

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Address*

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Date of Birth*

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Wallace Center Liability Waiver

I acknowledge that I am participating in the Wallace Center exercise programs, classes, and events, of my own free will, and I assume all risk and take responsibility for any injury I may suffer while participating in these programs, including related transportation, whether on-site, at an off-site location, or remotely. This Agreement and Release shall apply to all past, present, and future Wallace Center classes, events, whether on-site, off-site, or remote.

I hereby represent to the Wallace Center that I am not receiving medical treatment for any condition that might be aggravated or compromised by my participation in the Wallace Center’s exercise programs, classes, and events. I understand that the Wallace Center is relying on this representation in allowing me to participate in these exercise programs, classes, and events.

I am aware that the performance of exercise may involve certain inherent risk of accident or injury. By choosing to participate and with full knowledge of these risks, I hereby agree to personally assume all risks resulting from, arising out of, or in any way connected with, my participation in the Wallace Center’s exercise programs.

In consideration of being allowed to participate, I hereby release, agree not to sue and forever discharge, and by this document do for my heirs, executors, and administrators release, agree not to sue and forever discharge, the Wallace Center, The Town of Greenwich, Connecticut, and their respective officers, employees and agents, and any independent contractors hired on their behalf to provide the programs, classes, and events offered by the WCSA, from any actions, claims, liabilities, damages, judgments or losses which I now have or may incur as a result of my participation, whether on-site at the Wallace Center, at an off-site location, or remotely, or any activities incident thereto. Further, I hereby agree to indemnify, defend and hold harmless the Wallace Center, the Town of Greenwich, and/or any of their employees, officers, agents or volunteers from any claims, losses, causes of action, suits, costs and expenses (including, but not limited to, court costs and attorney fees) or other damages resulting from any injury, in any way associated with or resulting from my participation in the Wallace Center’s programs, classes, and events, whether on-site at the Wallace Center, at an off-site location, or remotely.

By entering the Wallace Center and/or by participating at a class or program at the Wallace Center, I understand that photography, audio or video may occur. I consent to the recording and release of my image, voice and/or name (“Recording”) for any purpose in connection with the Wallace Center including websites, social media, news and promotions. I waive and release the Wallace Center, the Town of Greenwich and its employees and agents of any claims related to the Recordings.

This Agreement supersedes any and all previous Agreements and/or Releases pertaining to my participation in activities or programs at the Wallace Center.

This Agreement shall remain in effect unless revoked in writing.

I have carefully read this document and fully understand its contents and effects. I have signed it freely and voluntarily.

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To complete your membership, please come to the Wallace Center Office to receive your membership card.

If you have any questions please contact us at 203-862-6707.