Disclaimer:
You should always consult with your doctor before beginning any type of exercise or physical liability. This form is an important legal document. It explains the risks you are assuming by beginning an exercise program. It is critical you read and understand it completely. Having done so, please print your name legibly and sign in the spaces provided.
Waiver, Informed consent, and covenant not to sue.
I have volunteered to participate in exercise, a class, or program containing physical exercise. I do here release and discharge and hereby hold harmless Lusk Athletic Club and their respective agents, heirs, assigns, contractors and employees from any and all claims, demands, damages, rights or causes of action, present and future, arising out of, or connected with my participation in this exercise, or any program, including any injuries resulting from them.
This waiver and release from liability includes, without limitation, injuries which may occur as a result of:
(1) my use of all amenities and equipment, and my participation in any activity, class, personal training or instruction
(2) Equipment that may malfunction or break
(3) the negligent instruction, or supervision by members of Lusk Athletic Club
(4) any slipping and/ or falling dropping of equipment, while on the Lusk Athletic Club premises.
Assumption of Risk
To my best knowledge I am in good physical condition and have no disease, physical limitation, health concern or injury that would be aggravated or would be the cause of any injury sustained, before, during or as a result of my participating in activities related either directly and/ or indirectly to Lusk Athletic Club. I recognise that exercise might be difficult and strenuous and there could be dangers inherent in exercise for some individuals. I acknowledge that the possibility of certain unusual physical changes during exercise does exist. These changes include abnormal blood pressure; fainting; disorders in heartbeat; heart attack; and, in rare instances, death. I understand that as a result of my participation in an exercise or other program, I could suffer an injury or physical disorder that could result in my becoming partially, or totally disabled and incapable of performing any gainful employment or having an everyday social life. I recognize that an examination by a physician should be obtained by all participants before involvement in any exercise or physical program. If I have chosen not to obtain a physician’s permission prior to beginning this exercise or physical program, I hereby agree that I am doing so at my own risk. In any event, I acknowledge and agree that I assume the risks associated with any and all activities and/ or exercises in which I participate. I acknowledge and agree that no warranties or representations have been made to me regarding the results I will achieve from this program. I understand that results are individual and may vary. I acknowledge that I have thoroughly read this waiver and release and fully understand that it is a release of liability. By signing this document, I am waiving any right, I or my successors might have to bring a legal action or assert a claim against Lusk Athletic Club, for negligence, or that of Lusk Athletics Club’s members, employees, agents, or contractors.
1) I confirm that I am a member of Lusk Athletic Club and have paid my subscription for the current year;
2) I can confirm that I am familiar with the equipment and have had sufficient training on the equipment to be able to use it responsibly;
4) I understand that I must not use the gym and any equipment therein unaccompanied;
5) I confirm that I will keep the equipment tidy and return all items used to their storage place;
6) I confirm that I will turn off lights, lock up and ensure that the premises are secure.
I certify that all the information I have provided is correct and true. All applicants must sign.
Parents or guardians must sign if the applicant is UNDER 18.
