Fit and Balanced Mom, LLC ASSUMPTION OF RISK AND LIABILITY I (the “Participant”), hereby acknowledge, affirm, and ratify the following: Whereas, Fit and Balanced Mom, LLC is in the business of providing fitness activities to clients and their child(ren) in my community; Whereas, I desire to participate in these fitness activities; Whereas, I understand that there is a certain amount of risk and liability I am assuming in order to be a part of these activities; and Whereas, I am willing to assume such risk of injury and liability for both me and my child(ren), in exchange for participation in Fit and Balanced Mom, LLC’s activities. In consideration of the foregoing, I agree as follows: 1. Assumption of Risk. a. I understand and am aware that strength, flexibility, and aerobic exercise, including the use of equipment, are potentially hazardous activities. I also understand that fitness activities involve a risk of injury and even death, and I am voluntarily participating in these activities and using equipment and machinery with knowledge of the dangers involved. I hereby agree to expressly assume and accept any and all risks of injury or death. 2. Representations and Warranties. a. To the best of my knowledge, I am physically sound and suffer from no condition, impairment, disease, infirmity, or other illness that would prevent my participation or use of equipment and machinery except as hereinafter stated. b. I have had a physical examination and consultation with my physician within the last year as to my physical activity, exercise, and use of exercise and training equipment and have been given my physician’s approval to participate in activities taught by Fit and Balanced Mom, LLC. 3. Agreements. a. I have completed the required Health History and submitted such form to Fit and Balanced Mom, LLC. Such Health History is hereby incorporated into this Assumption of Risk and Liability by reference. b. If I am within six weeks postpartum or have any known conditions that may affect my participation with activities taught by Fit and Balanced Mom, LLC, my physician has completed, and I have submitted to Fit and Balanced Mom, LLC, the Medical Clearance Form. The Medical Clearance form is hereby incorporated by reference into this Assumption of Risk and Liability. c. In the event that my information contained in my Health History changes, I agree to submit an updated Health History and/or an updated Medical Clearance Form to Fit and Balanced Mom, LLC, prior to participating in any activities taught by Fit and Balanced Mom, LLC. d. In the event that I experience any of the following conditions: chest pain while exercising, chest pain while not exercising, loss of balance due to dizziness, loss of consciousness, bone or joint problem that could worsen as a result of physical activity, prescribed medication for blood pressure or heart condition, doctor’s indication of a heart condition, or any other reason why I should not partake in physical activity, I agree to notify Fit and Balanced Mom, LLC, immediately and discontinue my participation in any and all of its activities. e. In the event that I experience any of the above conditions while participating in an activity taught by Fit and Balanced Mom, LLC, I agree to inform the staff immediately. f. I give permission for Fit and Balanced Mom, LLC to seek emergency medical services for me and/or my child(ren), should I become injured or ill during participation, with the understanding that I am responsible for any expense incurred. I fully understand that Fit and Balanced Mom, LLC does not provide any medical insurance coverage while participating in the program. 4. Waiver of Liability. a. I hereby waive and hold harmless Fit and Balanced Mom, LLC, its owner, Member(s), Managing Member(s), agents, employees, contractors, consultants, representatives, successors and assignees against all liabilities, claims, damages, and expenses of every kind and nature which grow out of or are in any way related to the conduct or organization of this program, whether a direct or indirect result of my participation in activities taught by Fit and Balanced Mom, LLC. b. I hereby waive and hold harmless the owner and/or operator of any facility where an activity taught by Fit and Balanced Mom, LLC is held, as well as its agents, employees, representatives, successors and assignees against all liabilities, claims, damages, and expenses of every kind and nature which grow out of or are in any way related to the conduct or organization of this program, whether a direct or indirect result of my participation in activities held by Fit and Balanced Mom, LLC. c. I hereby waive and hold harmless the other participants of activities taught by Fit and Balanced Mom, LLC, as well as their agents, employees, representatives, successors and assignees against all liabilities, claims, damages, and expenses of every kind and nature which grow out of or are in any way related to the conduct or organization of this program, whether a direct or indirect result of my participation in activities taught by Fit and Balanced Mom, LLC. 5. Successors and Assigns. a. This Assumption of Risk and Liability shall be binding upon and inure to the benefit of the parties hereto and their respective heirs, assigns, employees, representatives, and successors in interest. I HAVE CAREFULLY READ THIS AGREEMENT. I FULLY UNDERSTAND ITS CONTENTS AND SIGN IT OF MY OWN FREE WILL. *
