Group Fitness Liability Forms
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I wish to participate in the exercise, nutrition and life skills program offered by Empower Personalized Fitness L.L.C., (hereinafter “Empower”).  I understand there are inherent risks in participating in a program of strenuous exercise.  Consequently, I have been examined by a physician of my choice and have obtained his/her approval for my participation in a fitness program within sixty (60) days of the date set forth below to obtain his/her approval for my participation in a fitness program.  

I acknowledge the existence of risks, assume such risks, and accept responsibility for injuries to me arising out of activities in any of the following areas:  the use of facility equipment; the performance of fitness-related evaluations to assess functional capacity; the participation in group activities related to exercise and activity; and incidents which occur within the facility, locker rooms, dressing rooms, showers, and any other areas associated with Empower.

I agree that Empower shall not be liable or responsible for any injuries to me resulting from my participation in the fitness program (whether at home, outdoors, or at a corporate, commercial, residential or other fitness facility).  In consideration of gaining access to participation in activities with Empower, I do hereby waive, release, hold harmless and forever discharge Empower, its owners, officers, employees, representatives, executors, agents, independent contractors, and all others from any and all responsibilities, claims, actions, judgments and the like which I or my heirs, executors, administrators or assigns may have or claim to have as a result of any injury or other damage which may occur in connection with my participation in the fitness program, excepting only an injury caused by the willful misconduct or intentional act of such person or persons.  This Release shall be binding upon my heirs, executors, administrators and assigns.

I certify that the answers to the questions outlined on the PAR-Q form regarding health, nutrition and life skills are true and complete to the best of my knowledge.  I acknowledge that medical clearance is required if I have answered “Yes” to any of the questions on the PAR-Q form.  I understand and agree that it is my responsibility to inform my Personal Trainer of any conditions or changes in my health, now and ongoing, which might affect my ability to exercise safely and with minimal risk of injury.  In addition, I understand that it is seriously recommended that I consult with a physician before engaging in any activities associated with Empower.

I understand that I am not obligated to perform nor participate in any activity that I do not wish to do, and that it is my right to refuse such participation at any time during my training sessions.  I understand that should I feel lightheaded, faint, dizzy, nauseated, or experience pain or discomfort, I am to stop the activity and inform my Personal Trainer.

Having read the preceding, I acknowledge full understanding of the risks set forth herein and knowingly agree to accept full responsibility for my own exposure to such risks and to waive full responsibility and liability on behalf of Empower Personalized Fitness L.L.C.

Client’s Signature: *
Simply enter your full name here.
Please mark YES or NO to each of the following.
Has your doctor ever said that you have a heart condition and recommended only medically supervised physical activity? *
Do you frequently have pains in your chest when you perform physical activity? *
Have you had chest pain when you were not doing physical activity? *
Do you lose your balance due to dizziness or do you ever lose consciousness? *
Do you have a bone, joint or any other health problem that causes you pain or limitations that must be addressed when developing an exercise program? *
(i.e. diabetes, osteoporosis, high blood pressure, high cholesterol, arthritis, anorexia, bulimia, anemia, epilepsy, respiratory ailments, back problems, etc.)
Are you pregnant now or have given birth within the last 6 months? *
Have you had a recent surgery? *

We strongly encourage all clients to preregister for class online.  Class sizes are limited, and we cannot guarantee there will be spots available in class if you have not preregistered online.  You can log into your account on Mindbody through our website,


• Please check-in with the Team member at the front desk or the instructor immediately upon arriving at the studio for class.  Let them know your name and that you are there for a small group class session.

• Please try to arrive at the studio at least 10 minutes prior to class to ensure class can get started on time. If you are running late, but registered for class, please call the studio, (919) 401-8024, and let the instructor know to continue to hold your spot in class.

• If you need to purchase a new class pass or have a question about payment options, please check with your instructor before or after class. You can also purchase small group class memberships online through our Mindbody site.

• Participants will not be allowed into a class after the warmup has ended (about 5 minutes into class) for safety reasons.

• If you are late or arrive at the last minute for a full class your spot may be given to another participant that is on standby, even if you preregistered online. If you are running late, please call the studio (919)-401-8024 and let someone know you still plan to attend class and your spot will be held.

• Class participants are invited to use the lockers and changing facilities before, during and after class. We also have cubbies to house your belongings during class. However, we ask that unless you are a personal training client with a membership you do not use the equipment. If you are interested in these services, please ask any instructor or trainer for more details.


Billing Policy: Empower Personalized Fitness expects pre-payment for all small group class sessions. You can purchase either an Empower Fit Club membership or Class Pass.


• Pass cards are valid for three months from the date of purchase
• Pass cards Memberships can be shared between family members
• Prices are subject to change

• Term – month to month with automatic monthly renewal
• Group Training Sessions must be used within the month.
• Group Training sessions cannot be accumulated.
• Prices are subject to change at the discretion of Empower Personalized Fitness.

A member may cancel his/her monthly membership upon written notice of such cancellation no later than the five business days before the month in which cancellation is intended. Failure to issue timely notice will result in additional monthly draft/charges, which shall be nonrefundable.

Upon cancellation a member will be refunded any amounts prepaid for any months beyond cancellation.


• Cancellation Policy – Empower Personalized Fitness requires 2 hours’ notice when canceling a class. Early morning classes (6am-8am) require that you cancel by 8pm the previous night. No charge will be levied for cancellations that occur prior to this 2-hour window, and cancellations that occur within the 2-hour window or no shows will result in a one class deduction from your Empower Fit Club membership or pass card.

• Thanks for you for being a cooperative Empower client and being mindful of our scheduling and canceling policies. If you are unable to reach a computer to cancel in time please call or email to let us know.


• Wait list Policy – If a class is full you are encouraged to put yourself on the waitlist. You will be notified by email up to 2 hours prior to the start of class should a spot become available. At the start of class, open spots will be given to those on the waitlist. If a spot does open on the waitlist and you are put into class, the same cancellation policy applies.

• If you are on the waitlist and do not plan on coming, even if you are notified that you are in the class, please cancel your reservation online or call the studio (919) 401-8024.

• Clients who are on the wait list, or did not sign up online, will be allowed into a class once it starts provided there are open spaces, and will be charged accordingly.


• Pass Card holders may cancel at any time for a full refund on unused sessions. Pass Card cancellations will result in a $25 cancellation fee.

• Empower Fit Club memberships can be canceled up to 5 days prior to the next billing date.


I understand the results of any fitness program cannot be guaranteed and my
progress depends on my effort and cooperation in and outside of the sessions.

I understand that nutrition, life skills, and orthopedic advice and recommendations made by Empower’s trainers or instructors are based upon the answers provided in my PAR-Q form.

I understand that nutrition, life skills and rehabilitation exercises can be a valuable component of the training program, but do not guarantee results in weight loss or training goals.


I understand that it is my responsibility to inform the personal trainer or instructor of any significant changes in my health, which would impact my ability to pursue/achieve trainer’s goals outlined.


I understand that during a small group training session, my trainer or instructor may have to use Touch Training to correct alignment and/or to focus my concentration on a particular muscle area to be targeted.  If I feel uncomfortable or experience any type of discomfort with Empower Personalized Fitness L.L.C., I will immediately request that my trainer or instructor discontinue using this technique.


I understand that the usage of any nutritional supplements is done under my own will and has not been prescribed by my personal trainer or instructor.


I hereby expressly grant Empower Personalized Fitness L.L.C. and its employees, agents, and assigns, the right to photograph me and use my picture (film or digital), silhouette and other reproductions including motion picture footage and audio recordings of my physical likeness for the purpose of printed materials, art, promotional purposes (including, but not limited to, advertising, publicity, commercial or display use), illustration, exhibition, editorial, trade or any other purpose whatsoever.

I have read the preceding and acknowledge full understanding of its terms and those risks set forth herein and I knowingly agree to accept full responsibility for my own exposure to such risks and to waive full responsibility and liability on behalf of Empower Personalized Fitness L.L.C.  I understand the policies and procedures set forth by Empower Personalized Fitness L.L.C. and have had the opportunity to discuss my specific needs in relation to participatory activity and, as a result, I do voluntarily request the right to participate in this preventive program of exercise.  I sign this agreement voluntarily and with full knowledge of its significance.

I have read the conditions of this Agreement and understand that I may cancel this Agreement at any time prior to midnight of the third business day after the date of this Agreement.  To cancel, I must notify Empower in writing not later than midnight of the third business day after the date of this Agreement.

Client’s Signature: *
Simply enter your full name here.
A copy of your responses will be emailed to the address you provided.
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