The Active Workplace Liability Waiver
Use of Image and Likeness Release and Waiver of Liability, Indemnification and Hold Harmless Agreement
I, the undersigned, agree and understand that persons acting on behalf of The Active Workplace, LLC, a Massachusetts limited liability company with a corporate address of 73 Liberty Street, Massachusetts 01720 (“The Active Workplace”), may organize, lead, teach or otherwise provide certain fitness classes, yoga, stretching programs, meditation, chair massages, seminars, talks, weigh-ins, competitions, challenges, and related events at which I may be present (collectively referred to as “Classes”), and may provide instructional materials, including but not limited to videos, online resources, internet web pages, printed booklets, flyers, handouts, or other remote training materials related to health and physical fitness (collectively referred to as “Training Materials”).

I understand that persons acting on behalf of The Active Workplace may be taking photographs and/or may be making audio/visual digital recordings at the Classes. In consideration of participating in the Classes, the receipt and sufficiency of which are hereby acknowledged, I hereby irrevocably consent to and grant The Active Workplace, LLC and its authorized persons the right to use and/or reproduce: (i) any and all photographs, audio or visual digital recordings, or other recorded images of me or sound recordings which may include my voice, which may be recorded or otherwise obtained by The Active Workplace and that may include my person, image or likeness, and (ii) any and all audio, video recordings, or digital recordings of any kind which I may provide to The Active Workplace or which are recorded by The Active Workplace that contain my person, image, likeness, name or voice; for any lawful purpose whatsoever in connection with The Active Workplace, and/or the Classes. I represent and warrant that I have the proper rights in and to any photographs or audio or video recordings that I may provide to The Active Workplace. Any images or recordings made by The Active Workplace, LLC or by its representatives shall be and remain its exclusive property.

I hereby release The Active Workplace and its direct or indirect subsidiaries or affiliates, employees, contractors, officers, directors, agents, representatives, managers, members, sponsors, volunteers and any other entity or person acting on its behalf, and all of its successors and assigns and/or those authorized by The Active Workplace (collectively referred to as “Releasees”) from any and all claims for damages for libel, infringement of the right of publicity, invasion of privacy, portrayal in a false light, or any other claim based on use of the above-described materials.

By initialing here I indicate I read, understand and agree to the above: *
Your answer
I understand that by participating in the Classes, I may have enrolled in a program of intense physical exercise and activity, including, but not limited to, anaerobic and aerobic conditioning, weight training, body weight exercises, suspension training and the use of other conditioning equipment.

I agree to release, discharge, hold harmless and defend Releasees from any and all claims, demands, causes of action, responsibility and/or liability whatsoever by any persons for any property loss, damage, personal injury, or death, arising from or connected with my participation in the Classes, and/or use of Training Materials, including but not limited to that liability arising from any negligent acts of any person, including but not limited to the Releasees or other participants in the Classes. I further release Releasees from any claims, demands, causes of action, responsibility and/or liability arising out of or connected with any defects or dangerous conditions on the premises where Classes are held. I further release the Releasees from any claims, demands, causes of action, responsibility and/or liability arising out of my or any other person’s use of equipment and/or participation in the Classes or use of Training Materials.

I fully understand that my participation in The Classes and/or use of Training Materials entails a risk of injury and I hereby release the Releasees from any liability now or in the future for injuries including, but not limited to, heart attacks, stroke, muscle strains, pulls or tears, soft tissue injury, ligament or tendon injury, broken bones, shin splints, heat prostration, knee/lower back/foot injuries, and any other illness, soreness, injury or death, however caused, occurring during or after my participation in the Classes and/or use of Training Materials.

I do hereby further declare myself to be physically sound and suffering from no condition, impairment, disease, infirmity, or other illness that would prevent my participation or use of equipment or machinery. I do hereby acknowledge that I have been informed of the need for a physician’s approval for my participation in an exercise/fitness activity or in the use of exercise equipment or machinery. I also acknowledge that it has been recommended that I have a yearly or more frequent physical examination and consultation with my physician as to physical activity, exercise, and use of exercise and training equipment so that I might have his/her recommendations concerning these fitness activities and equipment use. I acknowledge that I have either had a physical examination and been given my physician’s permission to participate, or that I have decided to participate in activity and use of equipment and machinery without the approval of my physician and hereby assume all responsibility for my participation and activities, and utilization of equipment and machinery in my activities. I acknowledge the receipt and sufficiency of consideration in connection with the above releases, indemnifications and hold harmless provisions. I hereby affirm that I have read and fully understand and agree to the above.

Name *
Your answer
Email
Your answer
Company *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms