PSC Waiver Declaration
Please complete all entries below to be eligible to participate
Participant Name *
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Parent/Guardian if under 18 years old
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Participant Date of Birth *
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Contact Email Address *
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Contact Cell Phone *
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WAIVER & RELEASE I intend to use or participate in some or all of the activities, facilities, equipment, programs and services offered at or by Premiere Sportscenter. Premiere Sportscenter facilities are below referred to as “PSC”. 1. In consideration of gaining membership or being allowed such use or participation at PSC, in addition to the payment of any fee or charge, I do hereby waive, release and forever discharge PSC and its owners, officers, agents, employees, representatives, executors, successors and assigns from any and all responsibilities or liability for injuries or damages resulting from any participation in any aspect of any activities or programs or my use of equipment or machinery in PSC facilities or arising out of any activities or events occurring at PSC. 2. I understand and am well aware that strength, flexibility, fitness, exercise and sports activities, including the use of equipment, is potentially hazardous and there is the risk of injury and even death. I also understand that everyone (including myself) has a different capacity for participating in physical activities. I am also aware that all activities, facilities, programs and services at the PSC are either educational, recreational, social, or self-directed in nature. Knowing that, I agree that my participation in any and all of the activities at PSC is strictly voluntary and has not been requested or required by PSC. I further agree that my participation in any and all of the activities at PSC is at my own risk and that I assume any and all risk of injury, illness, damage or loss that might result. I also agree to assume all risk of damage, loss or theft to or of any of my personal property. 3. I hereby declare myself to be physically sound and suffering from no condition, impairment, disease, infirmity or other illness that would prevent my participation in any of the activities at the PSC. I acknowledge that I have either had a physical examination and have been given a physician’s permission to participate in these activities, programs, facilities and services at the PSC, or that I have decided to participate without the approval of my physician. Accordingly, I do hereby assume all responsibility for my participation in such activities, programs, facilities and services, as well as for my use of any and all equipment and machinery in connection with them. 4. Finally, I understand that the activities, facilities, equipment, programs and services offered at the PSC may sometimes be conducted by persons who may not be knowledgeable, licensed, certified or registered instructors or professionals. I accept the fact that the skills and competencies of PSC employees, agents, representatives or volunteers will vary according to their training and experience. I also understand that no claim has been or is being made by PSC to offer assessment or treatment of any mental or physical disease or condition by those who are not duly licensed, certified or registered and employed by PSC to provide such professional services. PARENT/GUARDIAN-CHILD AGREEMENT: I am hereby giving my consent and permission for my child to be an active member of PSC and to participate in the activities and programs for which they are registered. I understand that under certain circumstances they will be able to work out or participate in activities without direct supervision. I acknowledge that I am responsible for their actions, and that if they are not demonstrating proper usage of machines, facilities or equipment or exhibiting proper behavior, they will face appropriate disciplinary actions. I understand that PSC is a family atmosphere and that my child/children need my support, motivation, encouragement and supervision to succeed in a fitness or sports program, and I agree to provide it. *
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