Name *

First Name

Last Name

Phone *

(###)

###

####

Birth date *

MM

DD

YYYY

Emergency Contact #1 *

First Name

Last Name

Phone *

(###)

###

####

Emergency Contact #2

First Name

Last Name

Phone

(###)

###

####

Clearwater Fitness Center may take photographs and/or video of its participants while participating in our programs. Clearwater Fitness Center has the permission to use this media in any matter at all, photographs in whole or part, either by themselves or in conjunction with other promotional and advertising uses, and for other trade purposes. *

By checking this box, I state that I have read and agree to this release.

I, the undersigned, being aware of my own health and physical condition, am aware that there are significant risks involved in all aspects of physical training and sport. These risks include, but are not limited to: falls which can result in serious injury or death, injury or death due to negligence on the part of me, my training partner, or other people around me, injury or death due to improper use or failure of equipment. I am aware that any of these above mentioned risks may result in serious injury or death to me or my partner(s). I willingly assume full responsibility for the risks that I am exposing myself to and accept full responsibility for any injury or death that may result from participation in any activity or class while training with Clearwater Fitness Center. I, the undersigned acknowledge that I have no physical impairments or illnesses that will endanger myself or others. *

I Agree

In consideration of the above mentioned risks and hazards and in consideration of the fact that I am willingly and voluntarily participating in the activities taking place while training with Clearwater Fitness Center, I, the undersigned hereby release Clearwater Fitness Center, its principals, agents, employees, and volunteers, from any and all liability, claims, and demands, actions, or rights of action, which are related to, arise out of, or are in any way connected with my participation in these activities, including those allegedly attributed to the negligent acts or omissions of the above mentioned party. This agreement shall be binding upon me, my successors, representatives, heirs, executors, assigns, or transferees. If any portion of this agreement is held invalid, I agree that the remainder of the agreement shall remain in full legal force and effect. If I am signing on behalf of a minor child, I also give full permission for any person connected with Clearwater Fitness Center to administer first aid deemed necessary, ad in case of serious illness or injury, I give permission to call for medical and/or surgical care for the child and to transport the child to a medical facility deemed necessary for the well-being of the child. *

I Agree

I recognize that there is risk involved in any type of exercise and/or training program and specifically the training at Clearwater Fitness Center. Therefore, I accept financial responsibility for any injury that I may cause either to myself or to any other participant due to my negligence. Should the above mentioned parties, or anyone acting on their behalf, be required to incur attorney's fees and costs to enforce this agreement, I agree to reimburse them for such fees and costs. I further agree to indemnify and hold harmless Clearwater Fitness Center, its principals, agents, employees, and volunteers, from liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in activities offered by Clearwater Fitness Center. *

I Agree

Date Signed *

MM

DD

YYYY