Waiver for Fitness Services - Template, Sample Form

✓ Valid in Australia

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Waiver for Fitness Services - Template, Sample Form

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** IMPORTANT **

MESSAGE TO THE DOCUMENT CREATOR:

This document deals with a complicated area of law and serious legal risks.

It is possible that this document will not adequately address your circumstances.

This document is provided as a guide only and should always be reviewed by a lawyer before use.

This page may be removed before using this document with customers or participants.

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WAIVER, RELEASE, RISK WARNING, AND ACKNOWLEDGEMENT OF RISK

________ (hereinafter "Provider")
of ________

PARTICIPANT DETAILS (hereinafter "Participant"):

Participant Name: ________
Participant Address:

________

Emergency Contact: ________

THIS WAIVER (hereinafter "Waiver") relates to the Participant's participation in the following activity (hereinafter "Fitness Activity"): ________

The Fitness Activity is provided by the Provider.

IN CONSIDERATION for the Provider allowing the Participant to take part in the Fitness Activity, the Participant and the Guardian agree to the terms set out in this Waiver.

(1) Participant's Health and Pre-existing Conditions.

Place an "X" or a check mark next to the statements that are true:

................... I wear a pacemaker.

................... I wear contact lenses.

................... I wear a hearing aid.

................... I wear dentures.

If you experience pain or discomfort in any part of your body, please describe this pain or discomfort, including the location on the body and the cause, if known:

Describe your stress level:

.......................................................................................................................................
.......................................................................................................................................
.......................................................................................................................................
.......................................................................................................................................

List all injuries you have experienced in the past two years:

List any health disorders you have or any areas which may be sensitive to physical touch:

List all medications you are taking:

List any other information related to your health that may be important for the Provider to be aware of:

(2) Please carefully review each section below. By initialing each section, you confirm that you understand and agree to the relevant section:

................... The Fitness Activity may involve a number of exercises or activities including but not limited to: ________

................... Participation in the Fitness Activity involves risks which may include but are not limited to death, personal injury and damage to property. It may also involve specific risks including but not limited to: Head injuries, spinal damage, bone fractures, sprains, strains, muscle tears, ligament damage, bruises, abrasions, open wounds, dislocations, dehydration, heat stress, heart attack, stroke, cardiovascular complications, infection, disease, or any other injuries or illnesses related to overuse, exertion or exposure.

................... I warrant and represent that I understand the nature of the Fitness Activity and the risks involved with it.

................... I acknowledge and understand that I am choosing voluntarily to take part in the Fitness Activity and that I am free to refuse to participate in it at any time.

................... I warrant and represent that I am in good health and physical condition.

................... I warrant and represent that I do not suffer from any health condition which may affect my ability to safely participate in the Fitness Activity.

................... I acknowledge and agree that if I have any concerns or reservations about my health or my ability to participate safely in the Fitness Activity, I must take advice from a medical professional before taking part in the Fitness Activity.

................... I warrant and represent that if at any time I believe that the conditions of the Fitness Activity are unsafe for me (taking into account my own health and physical circumstances), I will immediately stop taking part in the Fitness Activity.

................... I understand that if I feel faint, dizzy, nauseous, or lightheaded, or experience chest pain or any other pain or discomfort, I must stop the Fitness Activity immediately and notify the Provider or a member of the Provider's staff.

................... I understand that the Fitness Activity is a supportive environment where health and well being are of paramount importance. We all progress at different rates and there is no shame in slowing down or taking a break.

................... I agree that I know my own body better than anyone else does and it is ultimately up to me to decide if the conditions of the Fitness Activity are unsafe for me, and to speak up if I have concerns.

................... I agree that I will comply with the Provider's rules and any directions given to me by the Provider or the Provider's staff members.

................... I warrant that I will compensate the Provider for any damage which I may cause to the Provider's equipment as a result of my recklessness or negligence.

................... I acknowledge that the Provider is not responsible for the safety or security of my personal belongings while I am taking part in the Fitness Activity. In the event that the Provider offers lockers or any other place to leave my personal belongings, I use these at my own risk.

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................... I agree to indemnify and hold harmless the Provider and the Provider's Representatives from and against any and all Liabilities, including legal costs on a full indemnity basis, arising out of or in connection with my participation in the Fitness Activity, except to the extent that such Liabilities arise out of the gross negligence of the Provider or the Provider's Representatives.

................... I authorise the Provider and the Provider's staff to provide first aid, to seek emergency medical support and/or to transport me to a medical facility in the event that I suffer an injury or medical emergency at any time. I acknowledge and accept that I will be responsible for any medical expenses that are incurred.

................... I authorise the Provider and the Provider's staff to take photographs or videos of me while participating in the Fitness Activity and to use such photographs or videos for promotional purposes including use on social media or other websites. I understand that if I do not want photographs or videos of me to be used by the Provider for promotional purposes, then I must notify the Provider of this in writing.

Financial Notice: In the event that you wish to cancel an appointment, you are required to give at least the following amount of notice: ________

If this notice is not received, the following will apply:

________

Severability: If any provision of this Waiver is found to be invalid, illegal or unenforceable, that provision shall be severed from this Waiver and the remaining provisions shall continue in full force and effect. The invalidity or unenforceability of any provision shall not affect the validity or enforceability of any other provision.

Applicable Law: This Waiver shall be governed in all respects by the laws of New South Wales and any applicable federal law.

I have read and understood this Waiver in its entirety. I acknowledge that by signing this Waiver I am giving up certain legal rights which I may have against the Provider, including the right to sue. I am assuming all risk and taking full responsibility for any personal injuries, death, loss or damage to property, liabilities or other losses which I might incur in relation to the Fitness Activity, and I am engaging in the Fitness Activity at my own risk.

I confirm that I have entered into this Waiver freely and voluntarily, without any inducement, assurance or guarantee being made to me, and that I have had the opportunity to seek independent legal advice before signing. I warrant that I am at least 18 years of age and of sound mind, and that all information I have provided in this Waiver is true and correct.Signed by the Participant:

..............................................
________

..............................................
Date

Witnessed by:

..............................................
Witness signature

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Witness name (print)

..............................................
Date

Fields you complete are inserted into the document live. This template is general guidance only — not legal advice.