Downtown Houston+ Fitness Classes

Emergency Contact and Telephone Number:

Are you currently experiencing any of the following conditions?

High Blood Pressure Heart/Circulatory Problems Neck/Back/Spine Injury Dizzy Spells/Fainting

Muscular Injury Pregnancy: How far along? Recent Surgery: (specify)

This form is an important legal document. It explains the risks you are assuming by beginning/participating in an exercise program. It is critical that you read and understand it completely. After you have done so, please print your name legibly and sign in the space provided at the bottom. with full knowledge and understanding that participation in the physical activities and fitness training services offered by Houston Downtown Management District, their subsidiaries or any of their affiliated companies, involves increased personal injury to me and/or my child/ward. Such personal injury may result from my own action or inaction and/or the action or inaction of others. I understand that this program might be difficult and strenuous and that there could be dangers inherent in exercise for some individuals. I acknowledge that the possibility of certain unusual physical changes during exercise does exist. These changes include abnormal blood pressure; fainting; disorders in heartbeat; heart attack; and in rare instances, death. Therefore, I assume all responsibility for any of the physical changes that could occur through my participation and/or my child's/ward's participation in any Houston Downtown Management District fitness program. I understand that as a result of my and/or my child/ward participation in an exercise program, I and/or my child/ward could suffer an injury or physical disorder that could result in becoming partially or totally disabled and incapable of performing any gainful employment or having a normal social life. I understand that I and/or my child/ward should consult a physician prior to beginning any activity program, including the Market Square Fitness / Stretch & Sweat / Stretch & Flow / Dynamic Sweat class I recognize that it is my responsibility to notify my and/or my child's/ward's instructor of any serious illness or injury before every class. I and/or my child/ward will not perform any postures to the extent of strain or pain. I also give full permission for any person connected with Houston Downtown Management District to administer first aid deemed necessary to me and/or my child/ward. In case of serious illness or injury, I give permission to call for medical and or surgical care for myself and/or my child/ward, and to transport me and/or my child/ward to a medical facility deemed necessary. I hereby grant permission to Houston Downtown Management District, and its employees, agents, representatives, licensees and assigns the right to photograph and/or video me and/or my child/ward, and use my and/or my child's/ward's image, likeness, voice, appearance and depiction. I hereby grant permission to Houston Downtown Management District to edit, crop, or retouch such photographs, and waive any right to inspect the final photographs.

I hereby consent to and permit photographs/video of me and/or my child/ward to be used by Houston Downtown Management District for purposes including but not limited to exhibition, publicity, advertising, and promotional materials and in any medium, including print and electronic without reservation or limitation. I understand that Houston Downtown Management District may use such photographs/video with or without associating names thereto. I further waive any claim for compensation of any kind for Houston Downtown Management District or publication of photographs of me and/or my child/ward.

I,ON MY OWN BEHALF, AND ON BEHALF OF MY CHILD/WARD LISTED BELOW, AGREE TO WAIVE, RELEASE, DISCHARGE AND HOLD HARMLESS DEFINE AND ITS RESPECTIVE OWNERS, OPERATORS, SUBSIDIARIES, AFFILIATES, OFFICERS, AGENTS, EMPLOYEES, VENDORS, CONTRACTORS, AND VOLUNTEERS ("RELEASED PARTIES") FROM ANY AND ALL LIABILITIES, INJURIES, ACCIDENTS, ILLNESSES, CLAIMS, DEMANDS, DAMAGES RIGHTS, OR CAUSES OF ACTION, PRESENT OR FUTURE, ARISING OUT OF, OR IN CONNECTION WITH: MY AND/OR MY CHILD'S/WARD'S MY USE OR PRESENCE ON THE PREMISES; (B) PARTICIPATION IN ANY OF DEFINE'S CLASSES OR EXERCISE PROGRAMS; (C) USE OF OR PUBLICATION OF PHOTOGRAPHS OF ME AND/OR MY CHILD/WARD BY DEFINE (INCLUDING, BUT NOT LIMITED TO, INVASION OF PRIVACY, DEFAMATION, FALSE LIGHT OR MISAPPROPRIATION OF NAME, LIKENESS OR IMAGE); (D) USE OF THE FACILITIES, EQUIPMENT, SERVICES, OR PROGRAMS, AND (E) MY AND/OR MY CHILD'S/WARD'S PARTICIPATION IN WORKSHOPS OR ACTIVITIES WITHIN OR OUTSIDE OF DEFINE'S LOCATIONS RESULTING FROM IN WHOLE OR IN PART BY A PRE-EXISTING DEFECT, THE NEGLIGENCE (WHETHER SOLE, JOINT OR CONCURRENT), GROSS NEGLIGENCE, STRICT LIABILITY OR OTHER LEGAL FAULT OF THE RELEASED PARTIES. ACKNOWLEDGEMENT AND UNDERSTANDING: I ACKNOWLEDGE THAT BY SIGNING THIS AGREEMENT, I HAVE CAREFULLY AND THOROUGHLY READ, FULLY UNDERSTAND, AND VOLUNTARILY ACCEPT AND AGREE TO ITS TERMS, INCLUDING UNDERSTANDING THAT IT'S A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY AND A WAIVER OF ANY RIGHT THAT I MAY HAVE ON BEHALF OF MYSELF AND/OR MY CHILD/WARD TO BRING A LEGAL ACTION OR ASSERT A CLAIM FOR INJURY OR LOSS OF ANY KIND AGAINST ANY OF THE RELEASED PARTIES FOR ANY REASON WHATSOVER. IF ANY ATTEMPT FOR SUCH CLAIM IS MADE, I AGREE TO FULLY INDEMNIFY AND HOLD THE RELEASED PARTIES HARMLESS AGAINST ANY AND ALL CLAIMS BROUGHT BY ANYONE AGAINST THE RELEASED PARTIES RELATED TO ANY SUCH INJURIES, HARM, OR DAMAGES.

THE HOUSTON DOWNTOWN MANAGEMENT DISTRICT REQUIRES THIS FORM BE SIGNED BEFORE PARTICPATION IN A DISTRICT-SPONSORED ACTIVITY. IF THIS FORM IS NOT SIGNED, YOU OR YOUR CHILD WILL NOT BE ALLOWED TO PARTICIPATE. IT IS A WAIVER OF RIGHTS. DO NOT SIGN IF YOU HAVE ANY QUESTIONS.

If you are signing on behalf of a minor, both parents must sign. In the case of a single-parent home, the custodial parent must sign. If you are registering your child for class electronically, completion of the registration will be considered your consent and agreement with this document. 1. You, for yourself and as appropriate on behalf of your child, hereby agree to release, waive and hold harmless the Downton District, its affiliate entities, agents, employees, volunteers and contractors of the entities (collectively referred to as "Releasees") from any and all liability arising from participation in recreation activities. 2. This release waives all claims whatsoever, known or unknown, which may arise by participation in the activity, including injury or death to self, damage to property, however such claim may arise, including but not limited to breaches of duty (such as breach of duty of care) and acts of current or future negligence by Releasees, their respective officers, employees or agents (nonexclusive examples are negligent care, supervision or control This release waives any claims whatsoever against the Releasees arising from the actions of any other participant in the activity or any other third party. Further, this release covers all activities immediately before and after participation, including transportation to or from the event and after the event. 3. The undersigned further agrees to defend and hold harmless Releasees, their respective officers, employees, or agents against any claim, cause, loss, cost or damage whatsoever, including attorney fees, that arises from the above-described activity. This release is specifically intended to indemnify the Releasees from any act of negligence of the undersigned. 4. Participation involves a risk of injury. By signing this form, you represent that you have considered the risks of participation in the activity, have obtained any medical clearance necessary to participate, and are able to participate without harm to yourself or others. You represent you will use any program equipment with care for yourself, other participants and your surroundings.

5. In the event of injury, fitness instructors are not trained to provide detailed medical care and shall not, without prior agreement, provide medications. All costs of emergency care are the responsibility of the participant/participants.

NO INSURANCE IS PROVIDED BY THE DOWNTOWN DISTRICT FOR INJURY TO PARTICIPANTS.

6. Parents or others may take audio or video recordings of the participants. The Downtown District does not supervise or restrict recordings of public activities by third parties. You agree that photos or videos may be used in promotional materials produced by the Downtown District to encourage participation in the activity. You agree to follow all rules of conduct established in conjunction with the activity. Failure to follow the rules will result in your removal from the activity, and you agree that any program fees paid will be kept and not refunded. In the event of a problem while engaged in the activity, notify the activity manager/supervisor. 8. This Release and Hold Harmless is given in partial consideration of your being allowed to participate in the activity described and binds yourself, your personal representatives and any heirs or assigns.

IHAVE CAREFULLY READ THIS RELEASE OF LIABILITY AND UNDERSTAND AND FULLY AGREE WITH ITS CONTENTS. I AM SIGNING THIS FREELY AND WITHOUT RESERVATION OR CONDITION.

If you have any questions about this document, do not sign it. Consult an attorney to assist you.

TO BE COMPLETED BY CLIENTS AGE 18 AND OVER

BY SIGNING BELOW, I ACKNOLWDGE I'VE READ AND UNDESTAND THE TERMS OF THIS CONSENT, WAIVER &

TO BE COMPLETED ON BEHALF OF MINOR CLIENTS UNDER THE AGE OF 18 BY SIGNING BELOW, I ACKNOLWDGE I'VE READ AND UNDESTAND THE TERMS OF THIS CONSENT, WAIVER & RELEASE OF LIABILITY