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Appleton Fitness for Life, Inc. d/b/a The Exercise Coach®
1901 E. Capitol Dr., Ste. A, Appleton, WI 54911
Release and Indemnification Agreement
Instructions: Please read, initial, complete, and sign this Release and Indemnification Agreement (hereinafter referred to herein as the “Release”). The headings in this Release are for convenience only and in no way define, limit or otherwise describe the scope or intent of this Release, or in any way affect the interpretation of this Release. No modifications, alterations, or changes to this Release have binding effect unless made in writing on a separate document entitled “Amendment to Release,” and signed by the Participant named herein and a member or officer of Appleton Fitness for Life, Inc. d/b/a The Exercise Coach®.
It is recommended that all participants in our personal training program consult with their physician prior to participation. Also an annual, or more frequent, physical examination is recommended.
Part I - Assumption of Risk
I, the undersigned to this Release, understand and am aware that flexibility, aerobics, strength training and other exercises, including the use of strength training equipment, is a potentially hazardous activity. I also understand that fitness activities carry a risk of injury** and even death, and I am voluntarily participating in these activities and using equipment and machinery with knowledge of the dangers involved. I hereby agree to expressly assume and accept any and all risks of injury or death associated with the foregoing activities.
**Such “risk of injury” includes, but is not limited to, the following: injuries arising from my or others’ use of exercise equipment and machines; injuries arising from participation by me or others in supervised or unsupervised activities or programs at any facility of The Exercise Coach (the “Facility”); injuries and medical disorders arising from exercising at the Facility such as heart attacks, strokes, heat stress, sprains, broken bones, and torn muscles and ligaments, among others; and accidental injuries occurring anywhere in the Facility.
Part II - Release of Claims
In consideration of the above factors and by my participation in The Exercise Coach® Personal Training Program ("Program"), I, intending to be legally bound for myself, my children, my next of kin, my heirs, executors, administrators, personal representatives, successors and assigns, do hereby waive, release, and forever discharge Appleton Fitness for Life, Inc. d/b/a The Exercise Coach®, The Exercise Coach USA, LLC, Gymbot, LLC, and their respective related entities, the sponsors of this Program, and their respective related entities, their respective agents, members, managers, officers, directors, employees, representatives, attorneys, successors, and assigns (collectively referred to as "Released Parties") from all liabilities, actions, claims, demands, damages, costs, expenses, fees, including attorneys' and other professional fees, which I may now have or may have in the future against them or any of them, known or unknown, arising out of or in any way connected with my participation in the Program, regardless of Facility location, including but not limited to, all injuries to my person or property, including injury leading to my death, that may be suffered by me. I understand that this Release includes, but is not limited to, any claims that are based on negligence or other action or inaction of the Released Parties. In consideration of the acceptance of my participation in the Program, I, the undersigned, indemnify, defend (by counsel acceptable to Appleton Fitness for Life, Inc. d/b/a The Exercise Coach®) and hold harmless the Released Parties against all liabilities, actions, claims, demands, damages, costs, expenses, fees, including attorneys' and other professional fees, of every kind and nature, without regard to the cause or causes thereof or the fault or negligence that arises from or is in any way connected with the conduct of any of the Released Parties, the organization of the Program, or my participation in the Program, including injuries and/or death relating therefrom. I further expressly agree that this Release is intended to be as broad and inclusive as is permitted by the laws of the State of WI, and that if any portion thereof is held invalid, it is agreed that the remainder of this Release continue in full force and effect.
Membership Agreement (Client Intake Form)
Part III - Physical Condition Attestation
I do hereby further declare myself to be physically sound and suffering from no condition, impairment, disease, infirmity, or other illness that would inhibit, adversely impact or prevent my participation in the Program or use of the machinery and equipment except as hereinafter stated in Part V below ("Existing Conditions"). I do hereby acknowledge that I have been informed of the importance of a physician's approval of my participation in an exercise/fitness activity or in the use of strength training equipment and machinery. I also acknowledge that it has been recommended I have a yearly or more frequent physical examination and consultation with my physician regarding my physical activity, exercise, and use of strength training equipment, so that I might have his/her recommendations concerning these fitness activities and equipment use. I acknowledge that I have either had a physical examination and have been given my physician's permission to participate, or that I have decided to participate in the Program and use of equipment and machinery without the approval of my physician and do hereby assume all responsibility for my participation and activities, and utilization of equipment and machinery in the Program.
Part IV- Changes in Health Conditions
I do hereby agree to promptly notify Appleton Fitness for Life, Inc. d/b/a The Exercise Coach® of any condition, impairment, disease, infirmity, or other illness that I may suffer in the future that may inhibit, adversely impact, or prevent my further participation in the Program or use of the machinery and equipment.
Part V – Specific Attestations
Unless noted below, I hereby acknowledge and represent to Appleton Fitness for Life, Inc. d/b/a The Exercise Coach® that:
i. I am not pregnant;
ii. I do not suffer from any heart or other cardiovascular condition;
iii. I do not suffer from any mental illness or other brain injury, illness, defect or abnormality, nor do I suffer from seizures, epilepsy or other neurological disorder;
iv. I do not suffer from spinal illness, injury or infection or other disease related to my back, spine, neck or spinal cord;
v. I do not suffer from any bleeding disorder or other blood related condition;
vi. I do not suffer from loss of hearing, sight, smell or other sensory loss; and
vii. I have not been advised by any physician, chiropractor or other health professional to avoid or abstain from weight training, aerobic exercise or other activities conducted by the Program.
viii. Specific exclusions to above:
Membership Agreement (Client Intake Form)
Part VI – Acknowledgement & Signature
By initialing above herein and signing below, I hereby acknowledge and confirm that I have read and I understand this entire document, I have had the opportunity to ask questions, and I agree that no oral representations, statements or inducements relating to the subject matter of this Release apart from this Release have been made. I acknowledge that I have no obligation to participate in the Program, and I am free to decline without any cost or penalty. Therefore, my participation in the Program signifies my acceptance of all the terms and conditions found within this Release.
PARTICIPANT’S PRINTED NAME
If Participant is Under 18:
PARENT/GUARDIAN’S PRINTED NAME