Please Submit Before Your Visit

Participant's Name

Parent/Guardian's Name (optional)

Emergency Contact + Phone Number

Release Part 1As a condition to and in consideration of being allowed to participate in the fitness activities and programs of Laid-back Fitness, LLC, a Rhode Island limited liability company, and to use its facilities, equipment and services, I (“I” meaning for myself and, if applicable, for and on behalf of any minor children of mine and for any other person(s) for whom I am the legal guardian) do hereby fully and forever waive, release and discharge Laid-back Fitness, LLC and its officers, agents, employees, representatives, executors and any and all others acting on its behalf (collectively the “Released Parties”), from any and all claims or liabilities of any nature for any and all harm, injuries or damages to my person, including to my health, and to any property of mine, including those caused by any negligent act or omission of any of the Released Parties of, related to, or connected with, my participation in any activities, programs or services of Laid-back Fitness, LLC or the use of any equipment at various sites, including in my or another home, provided by and/or recommended by Laid-back Fitness, LLC.

Release Part 2I acknowledge and understand and am otherwise aware that strength, flexibility and aerobic exercise, including the use of equipment and obstacles, is a potentially hazardous activity. I also acknowledge and understand and am otherwise aware that fitness activities involve a risk of bodily harm and injury, including a risk of death or serious disability, and that I am knowingly and voluntarily participating in these activities and using exercise, fitness and other equipment and with full awareness, understanding and appreciation of the dangers involved. I hereby assume and accept any and all risks of harm, injury or death.

Release Part 3I do hereby represent to Laid-back Fitness, LLC and other Released Parties that I am physically sound and suffering from no condition, impairment, disease, infirmity or illness that would prevent my participation in these activities or use of equipment or machinery. I agree that if I am not physically sound or am suffering from any condition, impairment, disease, infirmity or illness that would or may so prevent my participation that I shall inform Laid-back Fitness, LLC of the same prior to my engaging in any physical activity. I acknowledge that I have been informed of the need for a physician’s approval for my participation in the exercise activities, programs and use of exercise equipment. 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 equipment. I acknowledge that either I have had a physical examination and have been given my physician’s permission to participate, or I have decided to participate in the exercise activities, programs and use of equipment without the approval of my physician and do hereby assume all risks and responsibility for my participation in said activities, programs and use of equipment.

Release Part 4I understand that Laid-back Fitness, LLC providing and maintaining an exercise/fitness program for me does not constitute an acknowledgment, representation or indication of my physical well-being or a medical opinion relating thereto.

Release Part 5I understand that Laid-back Fitness, LLC may utilize photos and/or videos for promotional purposes and I hereby give them permission to utilize this material if it includes me or any members of my party.