711 James St Chicopee, MA 01020
FITCHICS UNLEASHED NUTRITION ONLINE
Waiver of Liability
This form is required prior to performing any activities with FitChics Unleashed Nutrition. Please fill out this form prior to attending any activities.
Waiver of Liability
In consideration of my participation in any and all FitChics Unleasehed Nutrition events and activities, I expressly agree and contract, on behalf of myself, my heirs, executors, administrators, successors and assigns, that the company and its insurers, employees, officers, directors, and associates, shall not be liable for any damages arising from personal injuries (including death) sustained by me, on, or about the premises, or as a result of the use of the equipment or facilities, regardless of whether such injuries result, in whole or in part, from the negligence of the company.
By the execution of this agreement, I accept and assume full responsibility for any and all injuries, damages (both economic and non-economic), and losses of any type, which may occur to me, and I hereby fully and forever release and discharge the company, its insurers, employees, officers, directors, and associates, from any and all claims, demands, damages, rights of action, or causes of action, present or future, whether the same be known or unknown, anticipated, or unanticipated, resulting from or arising out the use of said equipment and facilities.
I expressly agree to indemnify and hold the company harmless against any and all claims, demands, damages, rights of action, or causes of action, of any person or entity, that may arise from injuries or damages sustained by me or my guest. I agree to be solely responsible for safety and well being of my guest and myself. I understand that the company does not provide supervision, instruction, or assistance for the use of the facilities and equipment. I agree to comply with all rules imposed by the company regarding the use of the facilities and equipment. I agree to conduct myself in a controlled and reasonable manner at all times, and to refrain from using any equipment in a manner inconsistent with its intended design and purpose. I understand and acknowledge that the use of exercise equipment involves risk of serious injury, including permanent disability and death. I understand and agree that the company is not responsible for property that is lost, stolen, or damaged while in, on, or about the premises. I understand and agree that my use of the facilities and equipment is only to be undertaken on my own personal time, and that my use of the facilities and equipment is not within the course or scope of my employment.
Date of birth:
Select Relationship: (If under 18, form must be signed by parent or legal guardian only)
Name of person signing for above: (Only fill if legal guardian or parent):
I affirm that I have read and understood the details of the waiver of liability. By submitting this form to FitChics Unleashed Nutrition, I accept any and all responsibility. Furthermore, I waive any and all responsibility of FitChics Unleashed Nutrition, including their vendors, employees, sponsors, partners, and any person or company associated with FitChics Unleashed Nutrition.
Your signature, to prove you are not a robot, will be your drivers license number. If you do not have a drivers license, please bring a state or federal identification to the facility for one of our skilled trainers to verify. All information received will be protected under our
Drivers License/Identification Number:
District of Columbia--DC
Federated State of Micronesia--FM
Northern Mariana Islands--MP
Federal issued Passport
Other Federal/State ID
Children 17 years of age or younger that wish to use our facilities must be accompanied by a parent or legal guardian at all times. Parents cannot and will not be permitted to leave children under the age of 18 unaccompanied while they participate in our events.
Submitting this document will place your information in our database for a length of one (1) calendar year.
After one (1) calendar year you will be required to resign another waiver of liablity.