WAIVER & RELEASE FORM

In consideration of being allowed to participate in the group fitness, nutrition and electronic media health program of EMPOWERMENT and EXTREME COMPOUND (collectively hereinafter PWR) and to use its facilities, equipment and services, in addition to the payment of any fee or (print name) on behalf of myself, charge, I my heirs, individuals in my custody participating in the PWR program, executors, administrators, and assigns do hereby waive, release and discharge PWR from any and all claims of liability for injuries or damages to my person and/or property, including those caused by the negligent act or omission of PWR.

 

I am fully aware that participation in any fitness training activity and/or program may contain risks of physical injury. I know and understand the scope, nature and extent of the risks involved in the activities contemplated by this agreement. I am voluntarily participating in exercise and educational activities at PWR and use of the facilities and premises of PWR, and assume all risk of illness and injury, including permanent disability and death. I accept responsibility for my use of any and all equipment and fixtures provided by PWR. PWR will not be liable for any injury, including and without limitation, personal, bodily or mental injury, economic loss or any damage to me resulting from the negligent act, omission or other acts of PWR and their officers, agents, employees, representatives, instructors, staff and all others acting on behalf of PWR or anyone else using the facility.

 

I agree to specifically assume all risk of injury while using any of PWR's facilities, equipment, service or programs and hereby waive and fully discharge and release PWR from any and all liability, claims, demands, actions or causes of action that may arise against PWR as a result of injury including injuries arising from 1) the use of any exercise equipment and machines 2) injuries arising from participation in supervised or unsupervised activities, programs and classes within PWR or outside of PWR, 

to the extent sponsored or endorsed by PWR, and 3) injuries or medical disorders resulting from activities at PWR including, but not limited to heart attacks, strokes, heart stress, sprains, broken bones and torn muscles or ligaments and accidental injuries within the facilities of PWR, including but not limited to the locker rooms, the restrooms, the child-care center, the café, the cardio rooms and the weight room.

 

I acknowledge that I and those of whom I have custody have obtained a physical examination from a physician and received approval from said physician before using any exercise equipment or participating in any exercise activity. In the event that we do not choose to have a physical examination or have not beengiven a physician's approval for participation in activities, I acknowledge that by participating in any physical exercise or training activitiesat PWR, that we do so entirely at our own risk. PWR will not be liable for any injury, including and without limitation personal, bodily, or mental injury.

 

On behalf of myself, heirs, executors, administrators, minors of whom I have custody, and assigns I expressly agree to indemnify and hold harmless PWR against any and all claims, demands, damages, rights of action, of any person or entity that may arise from or caused by participation in wellness activities at PWR.

 

By participating in any group fitness, wellness activities and programs at PWR, I further consent to being photographed, videotaped, and/or recorded. I further consent to my image and/or likeness and those of the minors of whom I have custody being used without approval on any and/or all social media accounts, marketing materials, advertising or websites by PWR and their officers, agents, employees, representatives, executors, instructors and staff.

 

In the event that any damage to equipmentor the facilities at PWR occurs as a result of my or of those of whom I have custody willful actions, neglect or recklessness, I agree to be held liable for any and all costs associated with my or their actions of neglect or recklessness.

 

This Agreement shall be construed in accordance with and governed by the laws of the State of Ohio. If any provision of this Agreementis held invalid, the invalidity shall not affect other provisions of the Agreement that can be given effect without the invalid provisions, and to this end the provisions of the Agreementare to be severable. I acknowledge that I have carefully read this Release.I fully understand that it is a release of liability, as well as an express assumption of risk and indemnity agreement. I represent that I have the actual authority to, and do hereby enter into this release on my behalf, or as an authorized agent, parent or legal guardian for the minor(s) listed below.

I have read as well as voluntarily signed this Release. I further agree that no oral representations or statementsor inducements have been made to me to alter or modify anything within this written agreement.