I, [________________________________________________], acknowledge and voluntarily consent to participate in group fitness classes provided by Return to Center Wellness, LLC, a California limited liability company, and its directors, officers, group fitness instructors or other employees (together, the “Provider”), including, but not limited to, cardiorespiratory, muscular, and flexibility training (the “Classes”). I affirm that I am in good physical and mental health, and I am not aware of any medical condition that would be adversely affected by my involvement in an exercise program.

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I recognize and understand the inherent risks associated with physical fitness activities, including but not limited to the use of equipment. I am fully aware of the dangers involved in participating in these types of activities, even when performed properly, including the risks of serious injury, death, fainting, disorders in heartbeat, serious neck and spinal injuries that may result in complete or partial paralysis or brain damage, serious injury to virtually all bones, joints, ligaments, muscles, tendons, and other aspects of the musculoskeletal system, and serious injury or impairment to other aspects of my body, general health, and well-being. I agree to adhere to all instructions given by Provider.

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I am responsible for maintaining my own medical insurance coverage during my participation in the Classes, and will bear any costs that exceed my insurance benefits. I will promptly notify Provider of any significant injury or change in my health status requiring medical attention.

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I understand that I may provide personal equipment for use during the Classes, including, but not limited to, yoga mats, chairs, and similar items, and that Provider has not inspected this equipment and has no knowledge of its condition. I assume full responsibility for the condition and safety of my equipment. I represent and warrant that all equipment I provide for the Classes is for personal use only.  I acknowledge that while Provider takes reasonable steps to maintain their equipment, malfunctions may occur, and I agree to inspect all equipment prior to use, whether provided by myself or Provider.

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I expressly assume full responsibility for my safety and for any injuries that may occur during my participation in the Classes. In consideration of my participation, I waive and release any claims against Provider, the locations where classes are held, and their respective staff, officers, officials, volunteers, sponsors, agents, representatives, successors, or assignees (the “Released Parties”) for any personal injury, including death, and property damage resulting from my voluntary participation in these activities, to the extent such claims are not precluded by California law. This waiver does not extend to claims for gross negligence, willful misconduct, or any other liabilities that California law does not permit to be excluded by agreement.

I agree to indemnify and hold harmless the Released Parties from any claims or losses, including negligence, related to any injuries or expenses incurred during my participation or in transit to and from the Classes.

 

This release extends to the locations where the Classes are held and their directors, officers, employees and contractors, including Rise Pole Fitness, LLC; The Root; Rock Mama Gallery: and Remedy Massage Therapy, along with their respective owners, and I agree to comply with any additional liability waivers required by these locations.

 

I am executing this agreement voluntarily and with full knowledge of its significance, free from fraud or duress.

By signing below, I confirm that I have read and understood this document and agree to be bound by its terms.

 

Participant’s Information:

 

Full Name (please print clearly): ______________________________________________________

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Signature: Participant's Signature _____________________________________________________

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Date: _________________________________________

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Address: _____________________________________________________________________________

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Instructor’s Acknowledgment:

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Name: Anne Silvestri, CGFI

 

Signature: _________________________________________________________________________________

 

Date: ________________________________________