CLASS WAIVER, RELEASE, AND ASSUMPTION OF RISK for Minors Logo
  • WAIVER, RELEASE, AND ASSUMPTION OF RISK 

    To have your minor child participate in an Atlantic Physical Therapy Center Fitness Class
  • This Release of Liability Agreement (“Agreement”) is between you the client (“Client”) and Atlantic Physical Therapy Center, on behalf of itself and its related companies, affiliates and subsidiaries. It is agreed by the parties that Client is purchasing, for the benefit of Client, a physical fitness class, from Atlantic Physical Therapy Center, according to the terms hereof and Atlantic Physical Therapy Center Training Agreement. 
     
    Client has volunteered to participate in a fitness class provided by Atlantic Physical Therapy Center, which may include, but may not be limited to, strength training, mobility & flexibility training, cardiovascular exercise and nutritional advice.  
     
    IMPORTANT NOTICE: 
    In consideration of Atlantic Physical Therapy Center’s agreement to provide the fitness class, I agree to release Atlantic Physical Therapy Center from liability due to participation. CLIENT IS URGED TO HAVE THIS RELEASE AGREEMENT REVIEWED BY THEIR ATTORNEY BEFORE SIGNING. 
     
    CLIENT ACKNOWLEDGES THAT THE FITNESS CLASS PURCHASED HEREUNDER INCLUDES PARTICIPATION IN STRENUOUS PHYSICAL ACTIVITIES, INCLUDING, BUT NOT LIMITED TO, RUNNING, WEIGHT TRAINING, VARIOUS AEROBIC CONDITIONING, MACHINERY AND NUTRITIONAL ADVICE OFFERED BY ATLANTIC PHYSICAL THERAPY CENTER. CLIENT ACKNOWLEDGES THESE PHYSICAL ACTIVITIES INVOLVE THE INHERENT RISK OF PHYSICAL INJURIES OR OTHER DAMAGES, INCLUDING, BUT NOT LIMITED TO, HEART ATTACKS, MUSCLE STRAINS, PULLS OR TEARS, BROKEN BONES, SHIN SPLINTS, HEAT EXHAUSTION, KNEE/LOWER BACK/FOOT INJURIES AND ANY OTHER ILLNESS, SORENESS, OR INJURY, HOWEVER CAUSED, OCCURRING DURING OR AFTER CLIENT'S PARTICIPATION IN THE FITNESS CLASSES. CLIENT FURTHER ACKNOWLEDGES THAT SUCH RISKS INCLUDE, BUT ARE NOT LIMITED TO, INJURIES CAUSED BY THE NEGLIGENCE OF AN INSTRUCTOR OR OTHER PERSON, DEFECTIVE OR IMPROPERLY USED EQUIPMENT, MACHINERY, DEVICES OR FURNITURE, OVER-EXERTION, SLIP AND FALL, OR AN UNKNOWN HEALTH PROBLEM AND THAT CLIENT IS VOLUNTARILY PARTICIPATING IN THESE ACTIVITIES AND USES ANY EQUIPMENT, MATERIALS, DEVICES, FURNITURE OR MACHINERY WITH FULL KNOWLEDGE, UNDERSTANDING AND APPRECIATION OF THE DANGERS INVOLVED. CLIENT HEREBY AGREES TO EXPRESSLY ASSUME AND ACCEPT ANY AND ALL RISKS OF INJURY, REGARDLESS OF SEVERITY, OR DEATH.  
     
    CLIENT AGREES TO ASSUME ALL RISK AND RESPONSIBILITY ARISING FROM PARTICIPATION IN THE FITNESS CLASS. CLIENT AFFIRMS THAT CLIENT IS IN GOOD PHYSICAL CONDITION AND DOES NOT SUFFER FROM ANY DISABILITY THAT WOULD PREVENT OR LIMIT PARTICIPATION IN THE FITNESS CLASS. CLIENT ACKNOWLEDGES PARTICIPATION WILL BE PHYSICALLY AND MENTALLY CHALLENGING, AND CLIENT AGREES THAT IT IS THE RESPONSIBILITY OF CLIENT TO SEEK COMPETENT MEDICAL ADVICE REGARDING ANY CONCERNS OR QUESTIONS CONCERNING THE ABILITY OF CLIENT TO TAKE PART IN THE FITNESS CLASS. BY SIGNING THIS AGREEMENT, CLIENT AFFIRMS THAT HE/SHE/THEY IS/ARE CAPABLE OF PARTICIPATING IN THE FITNESS CLASS. CLIENT AGREES TO ASSUME ALL RISK AND RESPONSIBILITIES FOR EXCEEDING HIS/HER/THEIR PHYSICAL LIMITS. 
     
    CLIENT, ON BEHALF OF CLIENT, HIS/HER/THEIR HEIRS, ASSIGNS AND NEXT OF KIN, WAIVES ANY CLAIMS AGAINST AND RELEASES ATLANTIC PHYSICAL THERAPY CENTER AND ALL AFFILIATES (AS WELL AS ANY OF THEIR RESPECTIVE OWNERS, EMPLOYEES, OR OTHER AUTHORIZED AGENTS, INCLUDING INDEPENDENT CONTRACTORS) FROM ANY AND ALL LIABILITY, CLAIMS AND/OR CAUSES OF ACTION THAT CLIENT MAY HAVE FOR INJURIES OR OTHER DAMAGES OF ANY KIND, INCLUDING BUT NOT LIMITED TO PUNITIVE DAMAGES, ARISING OUT OF PARTICIPATION IN THE FITNESS CLASS, INCLUDING, BUT NOT LIMITED TO THE PERSONAL TRAINING/NUTRITIONAL PROGRAMS AND ALL PHYSICAL ACTIVITIES. 
     
    CLIENT ACKNOWLEDGES THAT CLIENT HAS THOROUGHLY READ THIS FORM IN ITS ENTIRETY AND FULLY UNDERSTANDS THAT IT IS A RELEASE OF LIABILITY. BY SIGNING THIS DOCUMENT, CLIENT WAIVES ANY AND ALL RIGHTS CLIENT OR CLIENT’S SUCCESSORS MIGHT HAVE TO BRING A LEGAL ACTION OR ASSERT A CLAIM AGAINST ATLANTIC PHYSICAL THERAPY CENTER OR ANY OF ITS AFFILIATES FOR THEIR NEGLIGENCE OR THAT OF THEIR EMPLOYEES, AGENTS, OR CONTRACTORS.  
     
    Client agrees that all terms and conditions of this Agreement shall be binding upon the heirs, personal representatives, lawful successors, and assigns of Client, and anyone claiming by or through Client. 
     
    The parties agree that if any provision or portion of this Agreement is declared void and unenforceable, such provision or portion of a provision shall be deemed severed from this Agreement, which shall otherwise remain in full force and effect. However, Client specifically agrees all the terms and conditions are to be enforced and Client specifically waives any statute or other right of any type, which would invalidate the enforceability of any provision or portion of a provision of this Agreement. 
     
    This Agreement shall be governed and enforced in accordance with the laws of the State of New Jersey. In the event either party finds it necessary to commence litigation or other court action to enforce the terms and conditions of this Agreement, the prevailing party in such litigation or court action shall be entitled to receive their actual attorney’s fees incurred, together with court costs, and other charges from the other party as a part of any ruling or judgment.  
     

  • I, Client,

  • have read, understood and completed this form honestly and to the best of my knowledge. I understand that Atlantic Physical Therapy Center assumes no liability for persons who undertake physical activity.

  • Clear
  •  - -
  • Clear
  •  - -
  • Should be Empty: