Waiver

Please complete the form below.

 
Participant's Name *
Participant's Name
Participant's Date of Birth *
Participant's Date of Birth
Address *
Address
(1) Parent/Legal Guardian Name
(1) Parent/Legal Guardian Name
(If the participant is a minor)
Parent/Legal Guardian Phone
Parent/Legal Guardian Phone
(If the participant is a minor)
Emergency Contact *
Emergency Contact
Emergency Contact's Phone *
Emergency Contact's Phone
Does the participant have any allergies? *
Does the participant require special care, or is the participant currently taking any prescription or over-the-counter medications? *
Is there any additional information or details that we should be aware of? *
Please indicate if the participant has ever been diagnosed with, or has a history of, any of the following:
Does the participant have problems in the following areas:
Medical Attention may be necessary from any injuries or accidents that may occur during physical activity. I hereby permit for the coach in charge and for Big Andy Training LLC to make arrangements for qualified medical attention for my child in the event of an emergency without requiring my prior approval. I understand that I will be notified by the quickest means possible.
Big Andy Training LLC will be periodically taking photos and videos of youth participating in classes and activities. These photos may be used on promotional marketing pieces, including but not limited to flyers, websites, and emails. I consent to the use of images of myself and/or my child as indicated above. When photos are used, we will confirm before hand.
I (including my Family Members and all guests) agree that if I engage in any physical exercise or activity or use any part of the club premises, I do so at my own risk. This includes, but is not limited to, my use of the locker room, sauna, parking area, sidewalk, any equipment in the club facility, and my participation in any activity, class, personal training, or instruction offered through the club whether indoors or outdoors. I agree that I am voluntarily participating in these activities and using the club facilities and premises and I assume all risk of injury, illness, damage or loss to me, or my property that might result, including, without limitation, the contraction of any illness or medical condition, or any loss or theft of any personal property. I realize that I am subject to injury from physical activity and that no form of pre planning can remove all dangers to which I am exposing myself. I have been informed of the risks involved and choose to participate with full knowledge & understanding of such risks. I am physically fit and know of no medical or health reason why I should not participate in exercise, in personal training, or in any other of the activities that take place in or with Big Andy Training LLC. I agree, on behalf of myself, my family members, and all guests (including personal representatives, heirs, executors, administrators, agents and assigns of each) to release and discharge Big Andy Training LLC (and its affiliates, employees, agents, representatives, successors, and assigns) from any and all claims or causes of action (known or unknown) occurring anywhere on the club premises; arising through the use of the club premises, its facilities and equipment; and/or through the participation in any activity, class, personal training, or instruction offered through the club whether indoors or outdoors. I, my family members, and all guests (including personal representatives, heirs, executors, administrators, agents and assigns of each) hereby waive all claims, demands, and causes of action against Big Andy Training LLC (and its affiliates, employees, agents, representatives, successors, and assigns) regardless of whether the injury (including death) or loss was caused by the negligence of Big Andy Training LLC (and its affiliates, employees, agents, representatives, successors, and assigns). This Waiver and Release does not pertain to acts of “gross negligence” on the part of Big Andy Training LLC (and its affiliates, employees, agents, representatives, successors, and assigns). I, my family members, and all guests (including personal representatives, heirs, executors, administrators, agents and assigns of each) further agree that if, despite this Waiver and Release, I or anyone on my behalf, makes a claim for any injury (including death) or loss to me, my family members, and all guests, I will indemnify, defend, and hold harmless the Big Andy Training LLC (and its affiliates, employees, agents, representatives, successors, and assigns) from any such claim or law suit. This includes reimbursing Big Andy Training LLC (and its affiliates, employees, agents, representatives, successors, and assigns) for all costs, expenses and attorney's fees incurred to defend any such claim or lawsuit. I acknowledge that I have carefully read this Waiver and Release and fully understand that it is a waiver and release of liability to full extent permitted by applicable law. I sign it of my own free will. I also understand that this contract is severable; in other words, if any part of it is held by a court of law to be unenforceable, the rest of it shall survive.