wellBEING Fitness Services Liability Waiver and Consent Form
Please read and sign this document carefully before participating in any services provided by our team.
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Full Legal Name of Participant: *
Date of Birth: *
Phone Number *
Emergency Contact Name: *
Emergency Contact Phone Number: *
Are you currently pregnant or have any known pre-existing medical conditions (e.g., heart condition, high blood pressure, recent surgery, chronic pain, etc.)? *
If you answered 'Yes' above, please describe your condition(s) and any relevant medications:
I confirm that I have voluntarily elected to participate in the physical activity, instruction, or wellness sessions offered by wellBEING. *
Required
Assumption of Risk: I acknowledge that participation in physical activity, exercise, and wellness programs inherently involves risk, including but not limited to, bodily injury, accident, illness, or property damage. *
Required
Waiver of Liability: I hereby release, waive, discharge, and covenant not to sue the service provider, its owners, agents, or employees from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me, or to any property belonging to me, while participating in such activity. *
Required
Photo/Video Release: I grant permission to use my likeness in photographs, videos, or other digital media for promotional or educational purposes.
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Participant Signature (Typing your name below serves as an electronic signature): *
Date of Signature:
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