Elevate Hickory Liability Waiver

This is a legally binding Consent Form and Release of Liability made voluntarily by me, the undersigned Releasor, on my own behalf, and on the behalf of my heirs, executors, administrators, legal representatives and assigns to the [Organization] (hereinafter "The Organization")

The undersigned hereby acknowledges that participation in any and all classes, parties, and events at Elevate Hickory involves inherent risk of physical injury and assumes all such risks. The undersigned hereby agrees that for the sole consideration of The Organization allowing the undersigned to participate in the above named activity for which or in connection with which the The Organization has made available any equipment, facilities, grounds or personnel for such programs or activities, the undersigned does hereby release and forever discharge The Organization, its members individually, and its officers, agents and employees of any and all claims, demands, rights and causes of action of whatever kind of nature, arising from and by reason of any and all known and unknown, foreseen and unforeseen bodily and personal injuries, damage to property, and the consequence thereof, resulting from participation in or in any way connected with the above named activity.

In an emergency, I acknowledge that I am solely responsible for all medical and other costs arising out of bodily injury or any loss sustained through participation in this activity. I authorize program staff to secure any licensed hospital, physician and/or medical personnel any treatment deemed necessary for the participant’s immediate care.

I understand that strength, flexibility, and aerobic exercise, including the use of equipment offered by Elevate Hickory is a potentially hazardous activity with certain risks and benefits, some of which include but are in no way limited to: soft tissue injuries such as wounds, bruises, muscle strain, muscle soreness, sprains, broken bones, head injuries, back/neck injuries, knee/foot injuries, heart attacks, death, improved cardiovascular fitness and flexibility, and increased strength and muscle tone.

By the execution of this agreement, I accept and assume full responsibility for any and all injuries, damages, and losses of any type, which may occur to me, and I hereby fully and forever release and discharge The Organization, its officers, employees, and insurers including any self‐insurance funds of the The Organization from any and all claims, demands, damages, rights of action, present and future, whether the same be known or unknown, anticipated or unanticipated, resulting from or arising out of my participation in classes, parties, and events at Elevate Hickory.

*I am not currently being treated for any medical condition that would prohibit me from safely participating in classes/parties/events offered by Elevate Hickory. These conditions include but are not limited to pregnancy, high blood pressure, heart disease, physical rehabilitation from prior injury, arthritis, and/or cognitive impairment.

*If a condition exists or develops which may prevent or restrict me from these activities I will obtain express permission and authorization from my medical provider to continue with such activities.

EMERGENCY CONTACT PERSON

Name

Relationship

Phone Number

Elevate Hickory studio and staff are not responsible for belongings left in the studio.

Electronic Signature and Acknowledgement

Enter the date and your full name to acknowledge your electronic signature of this document.

RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT

Date*

Your Full Name*

Your Electronic Signature*

Email Address