BEFORE SIGNING THIS ASSUMPTION OF RISK, WAIVER, AND RELEASE OF RIGHTS AND CLAIMS (THIS “AGREEMENT”),
YOU MUST READ IT VERY CAREFULLY. BY SIGNING THIS AGREEMENT, (A) YOU CONFIRM THAT YOU UNDERSTAND
AND AGREE TO ALL PARTS OF IT, AND (B) YOU AND/OR YOUR MINOR/WARD ARE GIVING UP LEGAL RIGHTS THAT
YOU AND/OR YOUR MINOR/WARD MIGHT OTHERWISE HAVE IN THE EVENT OF AN ACCIDENT INVOLVING ACTIVITIES
AT BURN BOOT CAMP. IF YOU DO NOT UNDERSTAND, OR YOU OBJECT TO, ANY TERM IN THIS AGREEMENT, YOU
SHOULD NOT SIGN IT, BUT SHOULD SEEK ADVICE FROM AN ATTORNEY. TO REQUEST CHANGES TO THIS AGREEMENT
CALL The Oak City Adventures, LLC. At 631-767-6066.
I recognize and acknowledge that as a participant in the Activities and as a recipient of the Services, I and/or my
minor/ward will periodically engage in strenuous physical activities involving the use of weight training or other
exercise equipment, which activities entail the risk of serious or 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 or death. I also understand that severe social or economic loss might result not only from my
own actions, inactions or negligence, but also from the actions, inactions or negligence of others, or the condition
of the premises or equipment used in connection with the Activities or Services. 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 or Services provided by The Oak City Adventures, LLC (the “Company”).
Good Judgment and Good Conduct. I warrant and represent that I am capable of using and shall use good judgment
with regard to my conduct and participation in activities (the “Activities”) and Child Watch services (the “Services”)
at or via Burn Boot Camp Williamsburg, VA. Most of the Activities will involve some level of physical exertion,
sometimes significant physical exertion, and I must and shall decide to participate in Activities only if and to the
extent I can reasonably participate and am comfortable doing so. I promise to not participate in Activities or Services
if I am uncomfortable or unsure regarding the safety or appropriateness of participating. I 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 the Company.
Appropriate and Sufficient Health, Medical, Physical, Mental, and Emotional Condition. I warrant and represent that
I am in appropriate and sufficient good health and medical, physical, mental, and emotional condition to participate
in the Activities that I will be participating in at or via Company and that I have no problems or issues which would
endanger me or others due to such participation. I further warrant and represent that I 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 their very nature
lead to a certain level of physical exertion and physical activity. I am only participating after giving informed consent,
including by way of this Agreement. By volunteering to participate in the Activities, I assume the risk of any negative
consequences which may result from the Activities, including as a result of actions or inactions by the Company, by
other activity participants or by third parties. If I am not aware of the risks of participating in the Activities, I should
not participate until and unless I have sought and received information from the Company which allows me to have
a fair and reasonable opportunity to know and understand said risks.
As to Services, I recognize and accept that: Services may be provided by people 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 I
am present on the premises; and even properly monitored children can and sometimes do end up with bumps,
bruises, scrapes, coughs, colds, and sometimes more serious injuries or conditions.
I understand the Company is taking reasonable precautions to limit my exposure to COVID-19 while at its premises,
using reasonable mitigation strategies that include, but are not limited to: separating sick employees; educating
employees about how to reduce the spread; practicing proper hand hygiene; encouraging me and others to stay at
least six feet apart while at the Company’s premises; discouraging handshaking and high fives; routine cleaning and
disinfection. I, too, agree to take reasonable precautions to limit the spread of COVID-19. The risks I assume and
claims I indemnify the Released Parties for include any associated with harmful viruses, including COVID-19.
ASSUMPTION OF RISK, WAIVER, AND RELEASE OF RIGHTS AND CLAIMS
Waiver and Release of Liability and Covenant not to Sue. I and anyone who can claim or recover through me
(“Releasing Parties”) hereby agree to waive, relinquish, discharge, release, and covenant not to sue or otherwise
bring a claim or complaint against, the Company or its parent, sister, affiliated and/or subsidiary companies or
related entities, their members, owners, officers, directors, partners, employees, consultants, contractors, advisors,
agents, insurers, attorneys or volunteers (“Released Parties”), from or for any and all rights, claims of injury,
demands, causes of action, damages, liabilities, or loss that Releasing Parties may have or come to have arising out
of, connected with, or in any way associated with the Activities or Services at or via the Company or with me
participating in or being present at any Company sponsored, organized or affiliated event or program or being on
property owned or controlled by the Company. This paragraph shall not be interpreted to attempt to waive or
release rights or claims which, by law, cannot be waived or released in this fashion.
Limitations on Damages in Case of Liability. Should Company somehow be found liable despite the terms of this
Agreement, I agree that the maximum amount of damages, fines or losses Company shall be liable for is the total
amount I have paid to Company in the twelve (12) months preceding the event first causing such liability of Company.
Company Indemnified, Defended, and Held Harmless. I hereby agree to indemnify, defend, and hold harmless the
Company, at no cost to Company, as to any claims or causes of action against Company (including any court costs
and legal or consulting fees) due or related to my participation in the Activities or use of the Services or related to
any action or inaction by me while on the Company’s property or while participating in or being present at any
Company sponsored, organized or affiliated function.
This Agreement’s Interpretation, Severability, Reformation, Completeness, and Finality. This Agreement shall not be
interpreted against either party as the “drafter,” and both parties have similar bargaining power, due in part to the
fact that you can choose to join a different organization which assists 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, a court with appropriate jurisdiction over the matter may 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 be
interpreted to accomplish the intent of the Agreement as stated herein. 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. Any dispute regarding this Agreement or any aspect of the relationship between me and the
Company that results in a legal or quasi-legal action shall only be held in a state court in James City County, VA.
Except as otherwise stated herein, each party will bear its own court costs and attorneys’ fees, except that if there
is a dispute regarding my non-payment of costs, fees or dues to Company, the prevailing party shall recover its costs
and fees relating to that dispute, including attorneys’ fees and any costs of collection, whether pre-litigation or
otherwise.
My Agent Executing on Behalf of Me. If I am unable to execute this document of my own accord for whatever reason,
and it is instead being executed by someone on my behalf (“My Agent”), My Agent hereby warrants, represents, and
swears that (s)he has the authority to execute this legally binding agreement on behalf of me and that Company
absolutely and materially relies on that warranty, representation, and sworn indication.
THIS IS A BINDING LEGAL AGREEMENT
I have read this Agreement thoroughly and fully understand it. I enter into it voluntarily on behalf of myself, my
heirs, next of kin, assigns, personal representatives, related individuals, and related entities. No one has made
any representation, statements or inducements that change or modify anything written in this Agreement.
______________________________________________________________________ ____/_____/_____
My Name Printed DOB
______________________________________________________________________ ____/_____/_____
My Signature Date
*COMPLETE THE BELOW ONLY IF RELEVANT
ASSUMPTION OF RISK, WAIVER, AND RELEASE OF RIGHTS AND CLAIMS
*If I am a minor or unable to sign / date, my name must still be written above and the below must be completed:
Burn Boot Camp Client PAR-Q and MindBody Profile Set Up
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? YES [ ] NO [ ]
If you answered YES to one or more questions, consult with your doctor BEFORE you start becoming more physically
active and 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 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 greater than 144/94, talk with
your doctor before you start becoming more physically active.
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.
ASSUMPTION OF RISK, WAIVER, AND RELEASE OF RIGHTS AND CLAIMS
Please complete the information below
Name__________________________________________________________________DOB____/____/_________
Email__________________________________________________________Phone__________________________
Address
_____________________________________________________________________________________________
City__________________________________________________________ State_______Zip__________________
Emergency Contact Name ________________________________________________________________________
Relationship ________________________________________ Phone Number _____________________________
Trial Start Date_________________ Trial End Date________________________
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 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.
Signature________________________________________________________Date____/____/______
