Liability Waiver/Acceptance of Responsibility of Risk
In consideration for participation in any activity, party, event or class at Fitwize 4 Kids Ashburn, VA, the undersigned, on his or her behalf, and on the behalf of the participant(s) identified below, acknowledges, appreciates and agrees to the following conditions:

I represent that I am the participant (if over 18) or parent or legal guardian (if participant is under 18) of the participant(s) named below, or I have obtained permission from the parent/legal guardian of the participant(s) named below to execute this agreement on their behalf. I agree that the participant(s) named below and I shall comply with all stated and customary terms, posted safety signs, rules and verbal instructions as conditions for participation in any activity, party, event, class and/or program at Fitwize 4 Kids. In addition, if I observe any hazard during our participation, I will bring it to the attention of the nearest Fitwize 4 Kids staff member immediately;

I am aware that there are inherent risks associated with participation in Fitwize 4 Kids activities, parties, events, classes, programs and/or use of the gym area and fitness equipment and I, on behalf of myself and the participant(s) named below, knowingly and freely assume all such risk, both known and unknown, including those that may arise out of the negligence of other participants; and,

I, for myself and the participant(s) named below, hereby release and hold harmless Fitwize 4 Kids, employees, other participants and sponsoring agencies from and against any and all claims, injuries, liabilities or damages arising out of or related to our participation in any and all Fitwize 4 Kids classes, activities, parties, events, the use of the sports arena and/or sports equipment.

In case of loss/damage of personal property, Fitwize 4 Kids, its owners, members and/or employees will not be held responsible. My signature below gives permission to use all photos and videos taken during programs for promotional purposes.

Participant Name *
Your answer
Date of Birth *
Your answer
School (type n/a if no longer in school) *
Your answer
Name of Participant (if over 18) OR Parent/Guardian (if participant is under 18) *
Your answer
Phone Number of Participant (if over 18) OR Parent/Guardian (if participant is under 18) *
Your answer
Email Address of Participant (if over 18) OR Parent/Guardian (if participant is under 18) *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone *
Your answer
Next
Never submit passwords through Google Forms.
This form was created inside of Fitwize 4 Kids. Report Abuse - Terms of Service