Amara's Fitness Center Waiver
Name
*
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Apartment Number
*
I am the:
*
Tenant of Record
Parent/Guardian of the tenant of record
Guest of Tenant
Parent/Guardian of a Minor between the ages of 16-17 Years Old.
If you are a guest, please specify your host:
First Name
Last Name
Name of Minor
First Name
Last Name
I, undersigned, agree with the following statements:
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I contract on behalf of myself, my heirs, executors, administrators, successors and assigns, that BQ 29, LLC, Block Management, Inc and its insurers, employees, officers, directors, and associates, shall not be liable for any damages arising from personal injuries (including death) sustained by me or the Minor I am signing on behalf of, on, or about the premises, or as a result of the use of the equipment or facilities, regardless of whether such injuries result, in whole or in part, from the negligence of the company.
I assume full responsibility for any and all injuries, damages (both economic and non-economic), and losses of any type, which may occur to me or the Minor I am signing on behalf of, and I hereby fully and forever release and discharge the company, its insurers, employees, officers, directors, and associates, from any and all claims, demands, damages, rights of action, or causes of action, present or future, whether the same be known or unknown, anticipated, or unanticipated, resulting from or arising out the use of said equipment and facilities.
I understand I am solely responsible for safety and wellbeing of the Minor I am signing on behalf of and/or myself. I understand that BQ 29, LLC, Block Management, Inc and its insurers, employees, officers, directors, and associates do not provide supervision, instruction, or assistance for the use of the facilities and equipment.
I understand and comply with all rules imposed by BQ 29, LLC and Block Management, Inc regarding the use of the facilities and equipment. I and/or my Minor will conduct myself/ourselves in a controlled and reasonable manner at all times, and to refrain from using any equipment in a manner inconsistent with its intended design and purpose.
I understand and acknowledge that the use of exercise equipment involves risk of serious injury, including permanent disability and death.
I understand that BQ 29, LLC and Block Management, Inc are not responsible for property that is lost, stolen, or damaged while in, on, or about the premises.
I understand and agree that my use of the facilities and equipment is only to be undertaken on personal time, and that my use of the facilities and equipment is not within the course or scope of my employment.
I RELEASE OF LIABILITY AND VOLUNTARILY EXECUTED THIS DOCUMENT WITH FULL KNOWLEDGE OF ITS CONTENT.
Date
*
-
Month
-
Day
Year
Date
FOR SECURITY, PLEASE UPLOAD A PHOTO OF YOUR FACE.
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By signing below, you acknowledge that you have read, understood, and agree to abide by the terms outlined in this disclosure regarding Fitness center
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