WAIVER AND RELEASE OF LIABILITY
In consideration of being allowed to participate in Provita session(s) and related events and activities, the undersigned acknowledges, appreciates, and agrees that:
1) I, the undersigned, being aware of my own health and physical condition, and having knowledge that my participation in a Provita session may cause injury, am voluntarily choosing to participate in the program. There are always certain risks associated with any physical activity. I understand these risks and declare myself physically sound and capable to participate in a Provita session. The risk of injury from the activities involved in this session may be significant, while specific instructions, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,
2) I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,
3) I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention to the professional trainer or teacher immediately; and,
4) I, for myself and on behalf of assigns, my heirs, and personal representatives, HEREBY RELEASE AND HOLD HARMLESS Provita, their officers, officials, agents, other participants, sponsoring agencies, sponsors, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
I have read this document in its entirety, fully understand its terms, and understand that I am giving up substantial rights – including my right to sue. I know, understand and appreciate these and other risks that are inherent in the Activity. I expressly agree and assert that participation in the Activity is voluntary and I knowingly assume all such risks and elect to proceed with the participation despite all the risks. I acknowledge that I am signing this document freely and voluntarily and intend, by my signature, the complete and unconditional release of all liability to the greatest extent allowed by law.
PROVITA CLIENT INTAKE FORM