Has your doctor ever said that you have a heart condition and/or that you should

only do physical activity recommended by a doctor?

In the past month, have you had chest pain when you were not doing physical

activity?

 Do you lose your balance because of dizziness, or do you ever lose consciousness?

Do you have a bone or joint problem (for example, back, knee or hip) that could

be made worse by a change in your physical activity?

 Is your doctor currently prescribing drugs (for example, water pills) for your

Blood pressure or heart conditions?

Do you know of any other reason why you should not do or partake in physical activity?

Do you have benefits with your insurance?

If you answered YES to one or more questions:

If you answered NO to all questions:

If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can:

RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT

THE FOLLOWING IS A WAIVER OF LIABILITY. READ IT BEFORE SIGNING. 

BY SIGNING THIS DOCUMENT, I AGREE THAT I AM TO BE LEGALLY BOUND BY ITS CONTENTS.  I ACKNOWLEDGE THAT IF I AM UNDER THE AGE OF 18 THAT MY PARENT OR LEGAL GUARDIAN MUST SIGN THIS FORM BEFORE I WILL BE PERMITTED TO UTILIZE THE FACILITIES.

I, the undersigned, hereby stipulate and agree in consideration for being permitted to participate in the exercise tests and physical activities and use of any equipment, the following:    

I acknowledge that undergoing the exercise tests, participating in the physical activities and use of any equipment is potentially very dangerous and may involve the risk of serious injury and/or death and/or property damage. 

I assume full responsibility for myself and my children for any risk of bodily injury, death, or property damage arising out of or related to the exercise tests, physical activities and use of any equipment whether caused by the conduct or negligence of the Trainer, Parris A. Weathersby, B.A.T.E. Fitness, or any of his or their family members, members, managers, or any of their employees, agents, or representatives, either individually or in a representative capacity or otherwise (herein collectively referred to as "RELEASEES").

I agree not to sue any of the "RELEASEES" and I forever release, waive, and discharge each of the RELEASEES from all liability to the undersigned, my children, my personal representatives, heirs, and next of kin for any and all loss or damage, claims or demands, causes of action, present and future, whether the same be known or unknown, or anticipated or unanticipated, on account of any injury to any person or property or resulting in death of the undersigned or my children arising out of or in any way related to the exercise tests, the physical activities and/or use of any equipment whether caused by the conduct or negligence of the RELEASEES or otherwise (an “Occurrence”).

I agree to indemnify and save and hold harmless the RELEASEES from any loss, liability damage, or cost they may incur arising out of or related to an Occurrence.

I agree that this Release And Waiver Of Liability, Assumption Of Risk, And Indemnity Agreement is intended to be as broad and inclusive as is permitted by the laws of the state of Ohio, and that if any portion hereof is invalid, it is agreed that the balance shall continue in full legal force and effect.

I HAVE CAREFULLY READ THIS AGREEMENT AND UNDERSTAND ITS CONTENTS.  I AM AWARE THIS IS AN ASSUMPTION OF RISK, A RELEASE AND WAIVER OF LIABILITY, AND AN INDEMNITY, AND I SIGN IT VOLUNTARILY.  I UNDERSTAND THAT I GIVE UP SUBSTANTIAL RIGHTS BY SIGNING IT, AM AWARE OF ITS LEGAL CONSEQUENCES, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME.  I INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW. 

Parental Consent if Participant is under 18 as of date of signature:

I am the parent or legal guardian of the above named Participant and by my signature below give the Participant permission to participate in the exercise tests/physical activity and execute this Waiver and Release on behalf of the named Participant as his/her parent and legal guardian.