Waiver & Release Form
Waiver & Release Form
Name
First
Last
Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
United States
United Kingdom
Canada
Australia
Netherlands
France
Germany
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Afghanistan
Albania
Algeria
Andorra
Antigua and Barbuda
Argentina
Armenia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
Gabon
Gambia
Georgia
Ghana
Greece
Grenada
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Country
Phone
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Email
Emergency Contact Name
First
Last
Emergency Contact Phone
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GROUP EXERCISE WAIVER AND RELEASE FORM
I have enrolled in the health and fitness group class offered by Fusion Personal Health Studio. I recognize that the class may involve strenuous physical activity including, but not limited to, muscle strength and endurance training, cardiovascular conditioning and training, and other various fitness activities.
I am fully aware of the risks and hazards involved in participating in a group health and fitness class and I understand that it is my responsibility to consult with a physician prior to attending the class offered by Fusion Personal Health Studio.
I represent and warrant that I am in good physical condition and I have no medical condition(s) that would prevent my full participation in any group health and fitness class offered by Fusion Personal Health Studio. I acknowledge that my enrollment and subsequent participation is purely voluntary and in no way mandated by Fusion Health Studio.”
In consideration for being permitted to participate in a group health and fitness class, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of my participation.
In further consideration, I knowingly, voluntarily and expressly waive any claim I may have against Fusion Personal Health Studio, its owners, instructors, independent contractors, employees, volunteers, and representatives, for any injury or damages that I may sustain as a result of my participation.
By submitting this waiver, I acknowledge that I have read the above release and waiver of liability and fully understand its contents and voluntarily agree to all of the terms and conditions.
This is the description of your section break.
I give Fusion Health Studio the express permission to take and use photos and videos for marketing and promotional purposes.
YES ___________ NO ___________
I give Fusion Health Studio the express permission to email me any news, promotions or marketing campaigns
YES ___________ NO ___________
Draw your signature into the box below.
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