Clive, IA

WHERE AS, the party executing this Agreement is a member or prospective member of the fitness facility operated by Evans Fitness, LLC an Iowa Limited Liability Company (also referred to as “Burn Boot Camp”, “BBC”, “we”, “Company” or “us” in this Agreement),

WHERE AS, the party executing this Agreement desires to utilize the services and engage in the activities offered by Company, and

WHERE AS, Company would not otherwise allow the executing party to participate in the same without signing this Agreement.

VOLLUNTARY SIGNATURE: YOU SHOULD NOT EXECUTE THIS AGREEMENT UNTIL AND UNLESS YOU COMPLETELY UNDERSTAND IT AND UNRESERVEDLY AND IRREVOCABLY CONSENT TO IT. THIS AGREEMENT IS LEGALLY BINDING. YOU HAVE THE RIGHT TO HAVE THE RIGHT TO HAVE THIS AGREEMENT REVIEWED BY AN ATTORNEY OF YOUR CHOICE, AND BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU FULL UNDERSTAND THE TERMS OF THIS AGREEMENT, AGREE TO BE BOUND BY THE SAME, AND ARE VOLUNTARILY AND FREELY ENTERING INTO THIS AGREEMENT AFTER CONSULTING WITH ANY ADVISOR OF YOUR CHOICE.
Good Judgment and Good Conduct by Releasee. Releasee warrants and represents that Releasee is capable of using and shall use good judgment with regard to Releasee’s conduct and Releasee’s participation in activities (the “Activities”) and/or Child Watch services (the “Services”) at or via Evans Fitness LLC (the “Company”). Most of the Activities shall involve some level of physical exertion, sometimes significant physical exertion, and Releasee must and shall decide to participate in Activities only if and to the extent Releasee can reasonably participate and is comfortable doing so. Releasee promises to not participate in Activities or Services if Releasee is uncomfortable or unsure regarding the safety or appropriateness of participating. Releasee will otherwise act in a manner which is respectful and safe toward others during and relating to Activities and Services at or via the Company and when participating in or being present at any Company sponsored, organized, or affiliated event or program and when on property owned or controlled by Company.
Appropriate and Sufficient Health, Medical, Physical, Mental, and Emotional Condition. Releasee warrants and represents that Releasee is in appropriate and sufficient good health and medical, physical, mental, and emotional condition to participate in the Activities that Releasee will be participating in at or via Company and that Releasee has no problems or issues which would endanger Releasee or others due to such participation. Releasee further warrants and represents that Releasee will not utilize the Services except when the child to be cared for is in good health, does not require any medications to be provided while the Services are being utilized, and does not pose an elevated risk toward others, including other children.
Informed Consent and Assumption of Risk. Participating in Activities at or via the Company will by the very nature of said Activities lead to a certain level of physical exertion and physical activity. Releasee is only participating after giving informed consent, including by way of this Agreement. By volunteering to participate in the Activities, Releasee assumes the risk of any negative consequences which may reasonably result from the Activities, including as a result of actions or inactions by the Company, by other activity participants, or by third parties. If Releasee is not aware of the risks which may come by participating in the Activities, Releasee should not participate until and unless Releasee has sought and received information from the Company which allows Releasee to have a fair and reasonable opportunity to know and understand said risks. Releasee further acknowledges that the negative consequences of engaging in the Activities may include, but not limited to, injury, health consequences, or other such consequences.
As to Services, Releasee recognizes and accepts that: Services may be provided by persons who are not child care professionals or otherwise licensed or permitted relating to child care; that the Company is not a licensed or permitted or certified child care facility; the Child Watch services are short-term, drop-in, basic in nature and may only be utilized while Releasee is present on the premises; and even properly monitored children can and sometimes do end up with bumps, bruises, scrapes, and sometimes more serious injuries or conditions.
Waiver and Release of Liability and Related Covenant. Releasee and anyone who can claim or recover through Releasee hereby agree to waive, relinquish, discharge, release, and covenant not to sue the Company or its parent, sister, affiliated and/or subsidiary corporations and related entities, their members, owners, officers, directors, partners, employees, consultants, contractors, advisors, agents, insurers, attorneys and volunteers, from any and all rights, claims of injury, demands, causes of action, damages, liabilities, or loss that Releasee and anyone who can claim or recover through Releasee may have or come to have arising out of, connected with, or in any way associated with the Activities or Services, including child care services, at or via the Company or with Releasee participating in or being present at any Company sponsored, organized, or affiliated event or program or being on property owned or controlled by Company. Releasee further covenants not to sue or otherwise bring a claim or complaint against Company for any of the matters waived and released herein. This paragraph should not be interpreted to attempt to waive or release rights or claims which, by law, cannot be waived or released in this fashion.
Company Indemnified, Defended, and Held Harmless. Releasee hereby agrees to indemnify, defend, and hold harmless the Company, at no cost to Company, as to any claims or causes of action against Company due or related to Releasee’s participation in the Activities or utilization of the Services or related to any action or inaction of Releasee while on Company’s property or while participating or being present in any Company sponsored, organized, or affiliated event or program.
This Agreement’s Interpretation, Severability, Reformation, Completeness, and Finality. The parties agree that the language of this Agreement shall not be interpreted against either party as the “drafter” and that both parties have similar bargaining power here, including since you can choose to join a different organization which assist with exercise and physical conditioning. If any part of this Agreement is found to be void, illegal, or otherwise unenforceable and if the court is able and willing to do so, the parties hereby grant a court with appropriate jurisdiction over the matter to reform or otherwise modify the Agreement if necessary to best accomplish the intent of the Agreement as stated herein. If the Agreement is not so modified, then the offending provision(s) shall be stricken but the remainder of the Agreement shall remain in effect and best interpreted to accomplish the intent of the Agreement as stated herein. The parties affirm that this Agreement is final and complete, and supersedes any other information which contradicts this Agreement, and cannot be amended except by further written agreement of the parties which is clearly intended to amend this Agreement.
Resolution of Disputes. Company does not expect to have any disputes with Releasees, but this issue is addressed in case that does occur. Should there be any disputes between regarding this Agreement or any other aspect of the relationship between Releasee and Company which results in a legal or quasi-legal action being initiated Iowa laws and rules shall apply to the extent allowable. Jurisdiction and venue for any legal or quasi-legal action shall only be with a state court in Des Moines, IA. Each party will bear its own court costs and attorneys’ fees except that if there is a dispute regarding Releasee’s non-payment of costs or fees or dues to Company, the prevailing party shall recover its legal costs and fees relating to that dispute, including attorneys’ fees and including any costs of collection, whether pre-litigation or otherwise.
Releasee’s Agent Executing on Behalf of Releasee. If the Releasee is unable to execute this document of his or her own accord for whatever reason, and it is instead being executed by someone on behalf of the Releasee (the “Releasee’s Agent”), the Releasee’s Agent hereby warrants, represents, and swears that (s)he has the authority to execute this legally binding agreement on behalf of the Releasee and that Company absolutely and materially relies on that warranty, representation, and sworn indication.
THIS IS A BINDING LEGAL AGREEMENT

_______________________________________________ _______________________________________________________
Releasee’s Name Printed Releasee’s Signature
________________________________________
Date of Signature
*COMPLETE THE BELOW ONLY IF RELEVANT
*If Releasee is a minor or unable to sign / date, Releasee’s name must still be written above and the below completed:
__________________________________________ ____________________________________________________________
Releasee’s Name Printed* Releasee’s Signature*
________________________________________
Date of Signature*

*Releasee’s Agent’s Relationship to Releasee:___________________________________________________________________
*By: Company

Name: ______________________________________________________

Dated: _______________________________ 
Please complete the information below

Name________________________________________________________________DOB_____________________
Email_________________________________________________________________________________________ Phone________________________________________________________________________________________
Address ______________________________________________________________________________________
City_______________________________________________ State______________Zip______________________
Signature_______________________________________________________Date___________________________
Emergency Contact Name ________________________________________________________________________
Relationship__________________________ Phone Number_____________________________________________
Burn Boot Camp Client PAR-Q and MindBody Profile Set Up
Please answer each question accurately and honestly; for each “Yes” answer, please briefly explain
1. Has any healthcare professional ever said that you have a heart condition and that you should only engage in physical activity as recommended by a doctor?

_________________________________________________________________________________ YES [ ] NO [ ]

2. Do you feel pain in your chest when you engage in physical activity?

_________________________________________________________________________________ YES [ ] NO [ ]

3. In the past month, have you had any chest pain when you were not doing physical activity?
_________________________________________________________________________________ YES [ ] NO [ ]

4. Do you lose your balance or ever lose consciousness, even if just briefly?

_________________________________________________________________________________ YES [ ] NO [ ]

5. Do you have a bone or joint problem (for example, back, knee, or hip) that could be made worse by a change in your physical activity?
_________________________________________________________________________________ YES [ ] NO [ ]

6. Is your doctor currently prescribing medications or any treatment regimen related to your blood pressure or heart condition?
_________________________________________________________________________________ YES [ ] NO [ ]

7. Do you know of any other reason why you should not engage in physical activity? For example; major surgery, artificial parts, implants or replacements, etc.
_________________________________________________________________________________ YES [ ] NO [ ]

If you answered YES to one or more questions, consult with your doctor BEFORE you start becoming more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and to which questions you answered YES. You may be able to do any activity you want – as long as you start slowly and build up gradually, or, you may need to restrict your activities to those that are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow his/her advice. Find out which programs are safe and helpful for you.
If you accurately answered NO to all PAR-Q questions, you likely can start becoming much more physically active – begin slowly and build up gradually. This is the safest and easiest way to go. Take part in a Focus Meeting– this is an excellent way to determine your basic fitness so that you can plan the best way for you to live actively. It is also highly recommended that you have your blood pressure evaluated. If your reading is over 144/94, talk with your doctor before you start becoming much more physically active.
However, regardless of how you answered the above questions and what may be true for most people, each of us is unique and you should always err on the side of caution with regard to physical safety, which may include seeking medical evaluations.
Please note that if your health changes so that you then answer YES to any of the above questions, you must tell your Burn Trainer and seek a medical evaluation from a physician, including advice as to future physical activities both in relation to Burn and otherwise. You and we will always want to make any reasonable modifications possible to your physical activity plan.
PLEASE COMPLETE THE FOLLOWING QUESTIONS IF YOU WERE PREGNANT WITHIN THE LAST YEAR:

In the past year, have you had a pregnancy/birth of a baby?

If you are less than 6 weeks post-partum please provide a doctor’s clearance note.

Type of delivery?

_____________________________________________________________________________________________

Any physical challenges that occurred?

__________________________________________________________________________

Breastfeeding? ________

Diastasis Recti / Incontinence / Pelvic Organ Prolapse?

___________________________________________________________

Delay becoming much more active if you are not feeling well because of a temporary illness such as a cold or a fever – wait until you feel better; or if you are or may be pregnant – talk to your doctor before you start becoming more active.