New Member Registration & Liability Release Agreement
Mini's House of Pain
Name *
First and Last
Your answer
Vista Sport *
Which High School Sport(s) do you play?
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Gender *
Member Date of Birth *
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Parent / Guardian Name
First and Last
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Mailing Address (Street) *
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City *
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State *
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Zip Code *
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Best Contact Number (no dash or space) *
9165555555
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Email *
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Emergency Contact Name *
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Emergency Contact Number *
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Emergency Contact Relationship *
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Agreement Purpose
Purpose of This Binding Agreement: By reading and signing this document, "You," the undersigned, sometimes also referred to as "User" or "I," will agree to release and hold Mini’s House of Pain Inc., and their respective agents, assignees, heirs and affiliates ("Releasee" or "We") harmless from, and assume all responsibility for, all claims, demands, injuries, damages, actions or causes of action to persons or property, arising out of or connected with your use of the Gym, premises, or services offered at 4990 Hillsdale Circle Ste. 100, El Dorado Hills, CA 95762, or other such locations as used by the company including off-site training locations utilized on an ad hoc basis. The agreement and release is for the benefit of the Gym, its employees, agents, independent contractors, other users of the Gym and all persons on the Gym’s premises. This agreement includes your release and indemnification of these persons from responsibility for injury, damage, or death to yourself because of those acts or omissions claimed to be related to the ordinary negligence of these persons. This agreement also includes your representations as to important matters that the Release will rely upon.
A: *
Waiver and Release of Liability: Representations: A. The undersigned, “You,” represent: (a) that you understand that use of the Gym, equipment, services and programs includes an inherent risk of injury to persons and property; (b) that you are in good physical condition and have no disabilities, illnesses, or other conditions that could prevent you from exercising and using the Gym’s equipment without injuring yourself or others, or impairing your health; and (c) that you have consulted a physician concerning an exercise program that will not risk injury to yourself or impairment of your health. Such risk of injury includes, but is not limited to, injuries arising from or relating to use by you or others of exercise equipment and machines, locker rooms, shower and other wet areas, and other Gym facilities; injuries arising from or relating to participation by you or others in supervised or unsupervised activities or programs through the Gym; injuries and medical disorders arising from or relating to use of the Gym including heart attacks, sudden cardiac arrests, strokes, heat stress, sprains, strains, broken bones, and torn muscles, tendons, and ligaments, among others; and accidental injuries occurring anywhere in or around the Gym including lobbies, hallways, exercise areas, bathrooms, outside walkways and parking areas. Accidental injuries include those caused by you, those caused by other persons, and those of a "slip-and-fall" nature. If you have any special exercise requirements or limitations, you agree to disclose them to the Releasee before using the Gym; and when seeking help in establishing an exercise program, you hereby agree that all exercise and use of the Gym facilities, services, programs, and premises are undertaken by you at your sole risk. You do hereby further declare yourself to be physically sound and suffering from no condition, impairment, disease, infirmity, or other illness that would prevent your participation or use of equipment or machinery except as hereinafter stated. You do hereby acknowledge that you have been informed of the need for a physician's approval for your participation in an exercise/fitness activity or in the use of exercise equipment and machinery. You also acknowledge that it has been recommended that you have a yearly or more frequent physical examination and consultation with your physician as to physical activity, exercise, and use of exercise and training equipment so that you might have his recommendations concerning these fitness activities and equipment use. You acknowledge either that you have had a physical examination and have been given your physician's permission to participate, or that you have decided to participate in activity and use of equipment and machinery without the approval of your physician and do hereby assume all responsibility for your participation and activities, and utilization of equipment and machinery in your activities. You are not permitted to use the Gym during non-supervised hours. You realize that if you use the Gym during non-supervised hours, any emergency response to you in the event of need for same may be impossible or delayed. You realize that a delay in the provision of first aid and/or emergency response may result in greater injury and disability to you and may cause or contribute to your death.
B: *
Waiver and Release of Liability: Express Assumption of All Risks: B. You have represented to us and acknowledged that you understand and appreciate all of the risks associated with your participation in various activities at the Gym and in the use of equipment, including the risks of injury, disability, and death. Knowing and appreciating all of these risks and enhanced risks, you have knowingly and intelligently determined to expressly assume all risks associated with all of your activities and use of equipment at the Gym. You understand and are aware that strength, flexibility and aerobic exercise, including the use of equipment, is a potentially hazardous activity. You also understand that fitness activities involve the risk of injury and even death, and that you are voluntarily participating in these activities and using equipment and machinery with knowledge of the dangers involved. We have also reviewed the risks with you on the date when you signed this Agreement and answered any questions that you may have had. You hereby agree to expressly assume and accept any and all risks of injury or death including those related to your use of or presence at the Gym, your use of equipment, and your participation in activity, including those risks related to the ordinary negligence of those released by this Agreement and including all claims related to ordinary negligence in the selection, purchase, setup, maintenance, instruction as to use, and use and/or supervision of use, if any, associated with all equipment and facilities. C. Agreement and Release of Liability In consideration of being allowed to participate in the activities and programs of the Gym and to use its equipment and machinery in addition to the payment of any fee or charge, you do hereby waive, release, and forever discharge the Releasee and their directors, officers, agents, employees, representatives, successors and assigns, administrators, executors, and all others from any and all responsibilities or liability from injuries or damages resulting from your participation in any activities or your use of equipment/facilities or machinery in the abovementioned activities. You do also hereby release all of those mentioned and any others acting upon their behalf from any responsibility or liability for any injury or damage to yourself, including those caused by the negligent act or omission of any of those mentioned or others acting on their behalf or in any way arising out of or connected with your participation in any activities of the Gym. This provision shall apply to ordinary acts of negligence but shall not apply to gross acts/omissions of negligence, willful or wanton acts/omissions, or those of an intentional/criminal nature.
C: *
Waiver and Release of Liability: Agreement and Release of Liability: C. In consideration of being allowed to participate in the activities and programs of the Gym and to use its equipment and machinery in addition to the payment of any fee or charge, you do hereby waive, release, and forever discharge the Releasee and their directors, officers, agents, employees, representatives, successors and assigns, administrators, executors, and all others from any and all responsibilities or liability from injuries or damages resulting from your participation in any activities or your use of equipment/facilities or machinery in the abovementioned activities. You do also hereby release all of those mentioned and any others acting upon their behalf from any responsibility or liability for any injury or damage to yourself, including those caused by the negligent act or omission of any of those mentioned or others acting on their behalf or in any way arising out of or connected with your participation in any activities of the Gym. This provision shall apply to ordinary acts of negligence but shall not apply to gross acts/omissions of negligence, willful or wanton acts/omissions, or those of an intentional/criminal nature.
D: *
Waiver and Release of Liability: Off-Site Special Events: D. From time to time, the Gym offers special events held outside of the normal Gym Facilities. By participating in those Off-Site Special Events, you hereby waive, release, hold harmless and forever discharge the Releasee and any promoting organizations, property owners, law enforcement agencies or other public entities, special districts and properties, and their respective agents, officials and employees from any and all responsibilities or liability from injuries or damages resulting from your participation in any activities you engage in during the Off-Site Special Event. This provision shall apply to ordinary acts of negligence but shall not apply to gross acts/omissions of negligence, willful or wanton acts/omissions, or those of an intentional/criminal nature.
E: *
Waiver and Release of Liability: Loss or Theft of Property: E. The Releasee are not responsible for lost or stolen articles. You should keep any valuables with you at all times while using the facilities. Storage space or lockers do not always protect valuables. Consequently, by executing this Agreement and any accompanying documents, you do hereby agree to assume all responsibility for your own property and that of any dependent(s) and to insure that property against risk of loss as you see fit. By the execution hereof, you expressly, on behalf of yourself and any dependents, do hereby knowingly agree to forego, waive, release, and prospectively give up any right to institute any claim or action against the Releasee relating to lost or stolen property, including property lost or stolen due to the negligent act or omission of the Releasee.
F: *
Waiver and Release of Liability: Payment & Termination: F. All payments are due on the 1st day of each month. Payments made after the 7th day of the month are subject to a $20 late fee. Gym privileges will be suspended if a monthly payment (plus applicable late charges) are not received by the 15th day of each month. Those individuals who are persistently late in paying fees will be asked to leave the Gym. You may terminate your membership by providing Vincent Mini with a 30-day written notice. If no notice is provided, you will be charged for one calendar month following your last day of attendance at the Gym
Membership Obligation: Financial Agreement *
Monthly payment will be $45 to VISTA TALON CLUB via URL on Minis House of Pain Webpage under the waiver link. All payments are due at the start of training and at the first session of the month. There is no pro rate option. Monthly due is always $45 regardless of start date. Next Month starts on the 1st of the month.
START DATE *
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G: *
Waiver and Release of Liability:Modifications, Waiver & Severability: This agreement may not be modified orally. A waiver of any provisions of this Agreement shall not be construed as a waiver of any other provision herein or as a consent to any subsequent waiver or modification. This Agreement shall be interpreted according to the laws of the State of California. If any part of this Agreement should ever be determined by a court of final jurisdiction to be invalid, the remaining portions hereof shall be deemed to be valid and enforceable.
Acknowledgement: INITIAL in BOX *
By typing name below I acknowledge that I have read and received a completed copy of this Agreement and any of its Exhibits, and have been apprised of any Rules and Regulations of the Gym, which are incorporated herein by reference. I agree to be bound by the terms and conditions of the Agreement and the Rules and Regulations of the Gym, as same exist or as same may be amended from time to time hereafter. This Agreement shall be binding upon me and my spouse, my heirs, my estate, my executors, my administrators, and my successors and/or assigns, I realize that this Agreement is designed to prevent me and/or them from filing any personal injury or other lawsuit based upon ordinary negligence, including negligent battery, or even negligent wrongful death, loss of consortium, or any other similar lawsuit arising out of any injury to me which I or they may possess hereafter. The undersigned, on behalf of myself and my heirs, executors, administrators, successors, and assigns hereby agree to indemnify the Gym and all those hereby released and to hold them absolutely harmless, including attorneys' fees and litigation expenses (specifically including Releasee’ attorney's fees and litigation expenses reasonably necessary to successfully enforce this indemnification provision) if anyone, including the undersigned, should hereafter file suit against the Gym or those released hereby for any matter intended to be released by this Agreement, including claims based upon ordinary negligence such as but not limited to personal injury, wrongful death, loss of consortium, or other similar actions. Initial Please
Your answer
Acknowledgement Date
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Financial Agreement *
Package Plan: MAKE PAYMENT VIA URL LINK TO VISTA TALON CLUB. THERE IS NOT PRO-RATE OPTION
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