ASSUMPTION OF RISK;
WAIVER AND RELEASE OF RIGHTS AND CLAIMS
I, the undersigned, recognize, acknowledge and understand that as a recipient of the personal training services provided by the MOM Fitness High Point, LLC (“MOM Fitness”), 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, by means of example and without limitation: 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 from one or more of the above 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 MOM Fitness.
Accordingly, I hereby expressly waive, relinquish, discharge, release, hold harmless, and covenant not to sue MOM Fitness and its parent, sister, affiliated, subsidiary, and/or related entities, their members, managers, owners, officers, directors, partners, employees, consultants, contractors, advisors, agents, insurers, attorneys, volunteers, successors and assigns (“Releasees”) from any and all rights, claims of injury, demands, causes of action, damages, liabilities or losses 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 MOM Fitness. 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 MOM Fitness 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.
I agree and acknowledge that in no event shall Releasees 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 MOM Fitness in the preceding 12 months, whether one time or in the aggregate.
I hereby agree to defend, hold harmless, and indemnify Releasees for any and all rights, claims of injury, demands, causes of action, damages, liabilities, losses, or fees (including reasonable attorneys’ fees) arising out of, connected with, or in any way associated with my negligent or reckless acts or omissions or violation of this Agreement. I represent and warrant that I have no medical or other condition, which would prohibit me from participating in any of MOM Fitness’s programs.
In addition to the assumption of risk, waiver, and release of claims described above, I also hereby consent to receive automated and non-automated telemarketing, advertising, informational and other phone calls and/or text messages from MOM Fitness to the phone number I have provided to MOM Fitness. I understand and agree that: (i) I am not required to grant consent as a condition of buying any goods or services, (ii) I may revoke my consent at any time by contacting MOM Fitness at [email protected]; and (iii) message and data rates apply.
This Agreement constitutes the entire agreement between the Parties on the issues contained in this Agreement and supersedes all prior and contemporaneous 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 (including the undersigned’s minor/ward or other family member) and their successors and assigns and the undersigned may not assign this Agreement without the express written consent of MOM Fitness.
This Agreement shall be governed by and construed in accordance with the laws of State of NC. All Parties irrevocably consent that the sole and exclusive venue and jurisdiction of any dispute shall lie in the federal or state courts of Guilford County, NC. In the event that a court of competent jurisdiction determines that any provision of this Agreement is invalid or unenforceable, all other provisions shall remain valid and enforceable 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.
Name_____________________________________________________________________DOB______________________________
Signature__________________________________________________________ Date_____________________________________
Email_____________________________________________________________ Phone # __________________________________
Emergency Contact/Number_____________________________________________________________________________________
What brought you to Burn?
Client Referral
Facebook
Instagram
Other: __________________________________________