DESIR FITNESS LIABILITY WAIVER AND RELEASE FORM
Address: 3 Locust Street, Washingtonville, NY 10992
Participant Information
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Emergency Contact
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
1. Assumption of Risk -I acknowledge that physical activities at Desir Fitness involve risks including injury, illness, or death from equipment use, workouts, or being on premises.
2. Medical Clearance - I confirm I am physically fit and assume responsibility for participation with or without medical clearance.
3. Release of Liability - I release Desir Fitness, its staff, and affiliates from any claims for injuries or damages, including those caused by ordinary negligence.
4. Equipment Use - I agree to use all equipment properly and accept responsibility for any injuries caused by misuse.
*
5. Media Release (Optional) -Do you give permission to Desir Fitness to use your photos/videos for promotion?
*
6. Minor Participants (Under 18) - This form must be signed by a parent or legal guardian.
Minor's Name
Last Name
DOB
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
7. Acknowledgement - I have read and understand this waiver and agree to the terms voluntarily.
Participant Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Parent / Guardian Signature (Under 18)
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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