Downtown Fitness Center Minor Liability Waiver

Minor Waiver / Downtown Fitness Center

1012B Manatee Ave W, Bradenton, FL 34205
This waiver grants access to minors covered under the YourChoice Health Plan age 14-17 to access the YourChoice Fitness Center, including weight room/cardio equipment and/or group fitness classes, when a guardian is present.

A Liability Waiver must be on file in order to gain access to the fitness center and/or utilize group fitness, personal training, etc. For questions regarding this form, please contact the YourChoice Fitness Center at 941.748.4501 x3979.

Please read the Liability Waiver Terms & Conditions prior to completing this form.

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Participant/Minor Information

To be filled out by legal guardian/parent.
Name:*

First NameLast Name
Date of Birth;*

MonthDayYear
Date
Phone Number:*
Phone Type:*

CellHome
Email:
example@example.com
Do you have any medical concerns?*

YesNo
If yes, please explain:
Emergency Contact Name:

First NameLast Name
Emergency Contact Phone Number:

Area CodePhone Number
Emergency Contact Relationship:
Employee Information
Employee's Name:*

First NameLast Name
Employee ID#*
Employee Agency:*

BCCCAOManatee ClerkElectionsHousingMSOPAOPortTCO
Department:
Acknowledgements:

By signing this form, I acknowledge that I have read the Liability Waiver Terms & Conditions and understand this agreement, and I realize it relates to surrendering and releasing valuable legal rights and do so freely and voluntarily.

I acknowledge misuse of this privilege will result in termination of fitness center access.

I also understand this waiver will expire in one year and a new waiver must be submitted to continue access to the Downtown Fitness Center.
Acknowledgments:*

I am a covered dependent on the Manatee YourChoice Health Plan age 14-17.I understand that I am required to have a parent present with me at all times while at the fitness center.I understand that misuse of this benefit will result in suspension of gym usage.
Participant Signature:*
Parent Signature:*
Should be Empty:

Minor Waiver / Downtown Fitness Center

Participant/Minor Information

Employee Information

Acknowledgements: