Name *
Name
Date of birth
Date of birth
Phone Number
Phone Number
Emergency Contact *
Emergency Contact
Emergency Contact Phone Number *
Emergency Contact Phone Number
RELEASE OF LIABILITY : *
BY SIGNING THIS DOCUMENT YOU ARE WAIVING CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE – PLEASE READ CAREFULLY : To: Anchored Fitness, its employees, affiliated community associations, and volunteers. Re: Anchored Fitness Training, Group Fitness Classes, Trail Clinics. Awareness of Risk: I acknowledge that there are risks associated with participation in any physical training, exercise, sports, adventure or outdoor activity program. I have informed myself and understand the risks associated with my participation in the orientation run and my use of the park location and facilities, including the risk of personal injury, and freely accept these risks. I understand that I am free to withdraw from or reduce my participation in the fitness program at any time. If I choose to do so, I will communicate this with the run leaders and accept the risk of not completing the run. I acknowledge that staff may limit my access to the Program or facilities in the event of any misuse of the facilities or misconduct on my part. I am not aware of any medical condition that would affect my ability to participate in the Program. If I have any concerns about my medical condition, I will consult with my physician before participating in the Program. RELEASE and WAIVER: In consideration of the acceptance of my participation in the orientation run, I hereby for myself, my heirs, executors, administrators, or any others who may claim on my behalf, covenant not to sue, and hereby waive, release and discharge Anchored Fitness, and anyone acting for or on Anchored Fitness behalf, from any and all claims of liability for personal injury, illness, loss of life or property damage of any kind or nature, arising out of or sustained in the course of my participation in the Program. I grant to Anchored Fitness, its representatives and employees the right to take photographs of me and my property in connection with the above-identified subject. I authorize Anchored Fitness, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Anchored Fitness may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. This Release and Waiver applies to all claims, foreseen or unforeseen, including negligence and breach of statutory or other duty of care (including that owed under the Occupier’s Liability Act). I recognize that by ticking this box I am waiving certain legal rights, including the right to sue.
I acknowledge that by submitting this form, I have carefully read about and understand the training I am registering for *