Plant city Fitness Registration Form

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Relationship to Contact Below

Emergency Contact Name

First NameLast Name

Emergency Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Health Acknowledgment

Zumba, hip-hop dance, belly dance , aerobic exercise, fitness classes, stretching and related activities involve physical exertion and may be strenuous. Participation may involve risks including muscle strains, sprains, falls, loss of balance, joint or back injuries, dizziness, dehydration, overexertion, shortness of breath, cardiovascular events, serious injury, permanent disability or death.

I understand the physical risks associated with participating in Zumba and fitness activities and voluntarily choose to participate.

Medical Clearance

I understand that the instructor, City of Plant City and class provider are not physicians or health-care providers and that these classes are not medical treatment. If I have a medical condition, injury, physical limitation or other concern that could affect my participation, I understand that I should consult an appropriate health-care professional before participating.

I have read and understand the medical/health acknowledgment above.

ASSUMPTION OF RISK

I knowingly and voluntarily assume the risks associated with my participation in Zumba, Hip-hop dance, dance fitness classes and related activities, including risks that are known or reasonably foreseeable and risks associated with the ordinary negligence of the Released Parties, to the fullest extent permitted by applicable law.

RELEASE OF LIABILITY

In consideration of being permitted to participate, I, for myself and for my heirs, personal representatives, successors and assigns, release and waive claims against the instructor, class provider/business, City of Plant City, facility owner or operator, and their respective owners, officers, employees, agents, contractors, volunteers and representatives (collectively, the "Released Parties") arising out of or related to my participation in the class or use of the facilities or equipment.

This release is intended to include claims arising from the ordinary negligence, acts or omissions of the Released Parties, to the fullest extent permitted by Florida law.

This release does not apply to liability that cannot legally be waived, including gross negligence, reckless conduct, intentional misconduct, or other liability that applicable law prohibits from being released.

MEDICAL EXPENSES

I understand that the class provider and instructor do not provide medical or accident insurance. If I become injured or ill, I understand that I am responsible for obtaining appropriate medical care and for any resulting medical, hospital, physician, medication, transportation or other expenses.

PERSONAL PROPERTY

I understand that I am responsible for my personal belongings. To the fullest extent permitted by law, I release the Released Parties from responsibility for loss, theft or damage to personal property brought to the class or facility.

PARTICIPANT SAFETY

I agree to follow reasonable instructions from the instructor, follow applicable facility rules, wear appropriate clothing and footwear, maintain adequate hydration, exercise within my abilities, and stop participating if I believe continuing would be unsafe.

LOUD, POSSIBLE EXPLICIT MUSIC & NOISE EXPOSURE
I understand that music may be explicit and played at elevated or loud volume levels during Zumba and fitness classes. Exposure to loud music may cause temporary or permanent hearing damage, including ringing in the ears (tinnitus), hearing loss, or other ear-related injury. I voluntarily accept the risks associated with exposure to loud music and understand that I may use appropriate hearing protection, move farther away from speakers, or leave the class area if the volume is uncomfortable or causes any symptoms.

I HAVE READ, UNDERSTAND, AND VOLUNTARILY AGREE TO THE ASSUMPTION OF RISK AND RELEASE OF LIABILITY ABOVE.

Send me promotions and special events updates via ?

Photo & Video Permission

I authorize the class provider/instructor to photograph or record me and use my image, likeness or voice for reasonable promotional, advertising, website or social-media purposes without additional compensation.

I have carefully read this Participant Waiver, Assumption of Risk & Release. I understand the nature and risks of participating in Zumba and fitness activities. I understand that I am voluntarily participating and that this agreement may affect my legal rights. I have had an opportunity to ask questions before agreeing to this document.

I confirm that I have read, understood and voluntarily agree to this Participant Waiver, Assumption of Risk & Release.

is participant a under age of 18yr?

Parent/Guardian Name

First NameLast Name

Parent/Guardian Relationship

Parent/Guardian Consent

Parent/Guardian Signature

Date

Signature