Body Shop Fitness - Customer Profile & Waiver
This profile and waiver must be completed before your first session at BSF, L.L.C.
Email address *
First name *
Last Name *
Birthdate *
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Cell Phone Number *
Other Phone Number
Mailing Address *
Emergency Contact Name *
Emergency Contact Phone Number *
Primary Care Physician's Name *
Primary Care Physician's Phone Number *
Hospital Preference *
Optional: Do you have any health conditions, past injury, or current injury that influence your level of activity? (this information helps our instructors plan specific modifications for you)
WAIVER- Please read the following ten statements and sign below.
1. I expressly agree and promise to accept all of the risks associated with this activity. My participation at Body Shop Fitness, L.L.C. is purely voluntary, and I elect to participate in spite of the risks.
2. I understand that the risks of exercise include, among other things: physical injury, loss of time at school/work, death, or the negligence of other participants, visitors, or other persons who may be present, or my own negligence. Furthermore, Body Shop Fitness, L.L.C. staff members have difficult jobs to perform. They may give inadequate warning or instructions, and equipment being used might malfunction.
3. I acknowledge, agree and represent that I understand the nature of said activities and that I am qualified, in good health, and have no medical condition preventing my safe participation in classes that I participate in. If at any time I believe the conditions to be unsafe for my participation, I will immediately discontinue further participation in said activity.
4. I hereby voluntarily WAIVE, RELEASE, DISCHARGE, COVENANT NOT TO SUE, and agree to INDEMNIFY and hold HARMLESS Body Shop Fitness, L.L.C. from any and all claims, demands, or causes of action, which are in any way connected with the
participation in this activity or my use of Body Shop Fitness, L.L.C. equipment or facilities.
5. I acknowledge, agree and represent that I understand that the use of the facilities owned and operated by Body Shop Fitness, L.L.C. exposes me to a risk of contracting an illness (i.e. common cold, influenza, COVID-19, etc.). If I should contract an illness, I hereby agree that I will cease to use the facilities until said illness has subsided. I further agree that I will not hold Body Shop Fitness, L.L.C. liable for contracting the illness or for any costs associated with the treatment of the illness.
6. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. If I have insurance, I have read and understood my policy and am aware of the extent of its coverage for injuries and damage that may be sustained while participating in this activity/event.
7. I hereby grant full permission to Body Shop Fitness, L.L.C., to use any photographs, images, videotapes, motion pictures, recording, or any other record of the activities or event for any lawful purpose and I understand that I shall not be entitled to any compensation therefore.
8. I understand I am solely responsible to receive medical approval prior to participating in classes at Body Shop Fitness, L.L.C..
9. I consent to emergency medical treatment in the event such care is required and release, indemnify, and hold harmless Body Shop Fitness, L.L.C. and its instructors and clients of and from any and all claims, demands, causes of actions, expenses, lawsuits, damages and liabilities, of every kind and nature, whether known or unknown, in law or equity, arising from such emergency medical care or treatment.
10. By signing my name below, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against Body Shop Fitness, L.L.C. on the basis of any claim.
Today's Date *
Your Signature (full name) *
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