BEFORE SIGNING THIS ACKNOWLEDGEMENT OF RISK, WAIVER, AND RELEASE OF CLAIMS (THIS “AGREEMENT”), YOU MUST READ THIS
AGREEMENT VERY CAREFULLY. IF AN ACCIDENT WERE TO OCCUR INVOLVING YOU AND/OR YOUR MINOR/WARD, YOU AND/OR YOUR
MINOR/WARD (BY SIGNING THIS AGREEMENT) WOULD BE GIVING UP LEGAL RIGHTS THAT YOU AND/OR MINOR/WARD MIGHT
OTHERWISE HAVE. IF YOU DO NOT UNDERSTAND ANYTHING IN THIS AGREEMENT, OR IF YOU OBJECT TO ANY PROVISION CONTAINED
IN THIS AGREEMENT, YOU SHOULD NOT SIGN IT BUT SHOULD SEEK ADVICE FROM YOUR LEGAL COUNSEL. REQUESTS FOR
MODIFICATIONS TO THIS AGREEMENT MAY BE DIRECTED IN PERSON TO Sunflower Fitness, LLC AND/OR BURN BOOT CAMP –
EVANSTON, IL.
I recognize and acknowledge that as a recipient of the personal training services provided by the Sunflower Fitness, LLC I and/or my minor/
ward will periodically engage in strenuous physical activities involving the use of weight training and other exercise equipment such as treadmills,
free weights, elliptical machines, exercise bikes, chest presses and squat racks among other equipment, which activities entail the risk of serious and
other injuries, including, but not limited to: broken bones, strains, sprains, bruises, concussions, heart attack, viral or other pathogen infection, and in
some cases, permanent disability and even death. I also understand that severe social and economic loss might result not only from my own actions
but also from the actions, inactions or negligence of others, or the condition of the premises or equipment used in connection with such activities.
Nevertheless, I agree to assume the risk of injury, damage, or loss regardless of severity that I, my minor/ward, or other family member or kin may
sustain as a result of the activities I engage in as the personal training services provided by Sunflower Fitness, LLC.
Accordingly, I agree to waive, relinquish, discharge, release, and covenant not to sue Sunflower Fitness LLC or its parent, sister, affiliated and/
or subsidiary corporations and related entities, their members, franchise partners, 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 I, my minor/ward, or other family member may have or that may accrue to me, my minor/ward, or other
family members arising out of, connected with, or in any way associated with the personal training services provided by the Sunflower Fitness
LLC. Notwithstanding the foregoing and any other provision of this Agreement, I do not waive any rights that I may seek redress due to the reckless
conduct of others or due to the conduct of others, which is both intentional and wrongful.
I have considered that if this Agreement were not as broad as it is, the cost of the personal training services provided to me and/or my minor/ward
by Sunflower Fitness, LLC would be considerably higher and I do not wish to pay a considerably higher cost. By signing this Agreement, I
waive the right to bargain for different terms in this Agreement. I also understand that if I later learn that any fact that I believed to be true at the time
I signed this Agreement is later to be found incorrect, I nevertheless am bound by this Agreement.
In no event shall Sunflower Fitness LLC be liable for any cause of action, claim, damage, demand, expense, fine, investigation, liability, or
penalty in excess of the amounts that I paid to Sunflower Fitness, LLC in the preceding 12 months, whether one time or in the aggregate.
I agree to defend, hold harmless, and indemnify Sunflower Fitness, LLC for any of my or my minor/ward’s negligent or reckless acts or
omissions. I warrant and represent that neither I, nor my minor/ward have any medical or other condition, which would prohibit me or my minor/
ward from participating in any of Sunflower Fitness, LLC programs.
This Agreement constitutes the entire agreement between the Parties on the issues contained in this Agreement and supersedes all prior
agreements and/or memoranda. This Agreement may only be modified in writing with the written consent of both Parties. This Agreement is
intended to bind only the Parties hereto, and their successors, and may not be assigned by either Party without the express written consent of the
other.
This Agreement shall be governed by the laws of the State of Illinois. All Parties irrevocably consent that the venue and jurisdiction of any dispute
shall lie in Cook County, IL In the event that a court determines that any provision of this Agreement is invalid, all other provisions shall survive and
the Agreement shall be interpreted to fulfill the intent of the Parties as shown in this Agreement.
I have read this Agreement thoroughly and fully understand it. I enter into it voluntarily on behalf of myself, my spouse, my heirs, next of
kin, assigns, personal representatives, related individuals and related entities. No one has made to me any representations statements, or
inducements that change or modify anything written in this Agreement.
Name_____________________________________________________________________DOB______________________________
Signature__________________________________________________________ Date_____________________________________
email_____________________________________
____________________________________________________________________________________________
Burn Boot Camp [email protected]
Copyright ©
BEFORE SIGNING THIS ACKNOWLEDGEMENT OF RISK, WAIVER, AND RELEASE OF CLAIMS (THIS “AGREEMENT”), YOU MUST READ THIS
AGREEMENT VERY CAREFULLY. IF AN ACCIDENT WERE TO OCCUR INVOLVING YOU AND/OR YOUR MINOR/WARD, YOU AND/OR YOUR
MINOR/WARD (BY SIGNING THIS AGREEMENT) WOULD BE GIVING UP LEGAL RIGHTS THAT YOU AND/OR MINOR/WARD MIGHT
OTHERWISE HAVE. IF YOU DO NOT UNDERSTAND ANYTHING IN THIS AGREEMENT, OR IF YOU OBJECT TO ANY PROVISION CONTAINED
IN THIS AGREEMENT, YOU SHOULD NOT SIGN IT BUT SHOULD SEEK ADVICE FROM YOUR LEGAL COUNSEL. REQUESTS FOR
MODIFICATIONS TO THIS AGREEMENT MAY BE DIRECTED IN PERSON TO Sunflower Fitness, LLC AND/OR BURN BOOT CAMP –
EVANSTON, IL.
Burn Boot Camp Client Questionnaire
If you answered YES to one or more questions:
Talk with your doctor by phone or in person BEFORE you start becoming more physically active or BEFORE you have a fitness
appraisal i.e. Focus Meeting. Tell your doctor about the Questionnaire 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 community programs are safe and helpful for you.
If you answered NO honestly to all questions on the Questionnaire, you can be reasonably sure that you 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.
PLEASE NOTE:
If your health changes so that you then answer YES to any of the above questions, tell your Burn Trainer. Ask whether you should
change your physical activity plan.
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.
Name_____________________________________________________________________DOB______________________________
Address__________________________________________________________________Phone_________________________
City_________________________________________________State________________ Zip____________________________
YES [] NO [] 1. Has your doctor ever said that you have a heart condition and that you should only do
physical activity recommended by a doctor?
YES [] NO [] 2. Do you feel pain in your chest when you do physical activity?
YES [] NO [] 3. In the past month, have you had chest pain when you were not doing physical activity?
YES [] NO [] 4. Do you lose your balance because of dizziness, or do you ever lose consciousness?
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 drugs (for example, water pills) for your blood
pressure or heart condition?
YES [] NO [] 7. Do you know of any other reason why you should not do physical activity?
__________________________________________________________________________________________
