Name *

First Name

Last Name

DATE OF BIRTH *

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(A) Services covered: *

Covered under this waver for Backyard Barbell and Fitness Club, LLC is any and all services provided by Backyard Barbell and Fitness Club, LLC for fitness related activities, including but not limited to weight training, group fitness, cardiovascular training, machine training, powerlifting, olympic weight lifting, cross training, etc.

I Understand.

(B) Express assumption of risk: *

I, the undersigned, hereby assume all of the risks of participating in physical training at Backyard Barbell and Fitness Club, LLC and, I am aware that there are significant risks involved in all aspects of physical training. These risks include but are not limited to: falls which can result in serious injury or death; injury or death due to negligence on the part of myself, my training partner, or other people around me; injury or death due to improper use or failure of equipment; strains, and sprains. I am aware that any of these above mentioned risk may result in serious injury or death to myself and or my partner(s). I willingly assume full responsibility for the risks that I am exposing myself to and accept full reasonability for any injury or death that may result from participation in any activity or class while at, or under of Backyard Barbell and Fitness Club, LLC Further, I acknowledge that I am physically fit to begin physical training and that I have no physical impairments, injuries, or illness that will endanger me or others. I have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in this activity.

I Understand.

(C) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me. *

In consideration of the above mentioned risks and hazards and in consideration of the fact that I am willingly and voluntarily participating in the activities offered by Backyard Barbell and Fitness Club, LLC, I the undersigned hereby release Backyard Barbell and Fitness Club, LLC , their principals, agents, employees, and volunteers from any and all liability, claims, demands, actions or rights of action, which are related to, arise out of, or are in any way connected with my participation in this activity, including those allegedly attributed to the negligent acts or missions of the above mentioned parties. It is my express intent that this agreement shall be binding upon me, my successors, representatives, heirs, executors, assigns, or transferees. If any portion of this agreement is held invalid, I agree that the remainder of the agreement shall remain in full legal force and full effect.

I Understand.

(D) CANCELLATION POLICY *

You may cancel your Membership Agreement at any time by providing written notice to Backyard Barbell no less than 10 business days prior to the due date of your next payment. Failure to provide timely notice will result in a charge for the full amount of your next billing payment. The cancellation will take affect the subsequent month. At the time of cancellation, you will be required to pay 50% of the remaining balance of outstanding future payments on your contract. Please note that the cancellation fee applies only to contract membership plans. Cancellation Fee = 50% of Monthly Membership Price * # of Months remaining on contract

I agree

Indemnification: *

The participant recognizes that there is risk involved in the types of activities offered by Backyard Barbell and Fitness Club, LLC. Therefore, the participant accepts financial responsibility for any injury that the participant may cause to either him/herself or to any other participant due to his/her negligence. Should the above mentioned parties, or anyone acting on their behalf, be required to incur attorney’s fees and cost to enforce this agreement, I agree to reimburse them for such fees and cost. I further agree to indemnify and hold harmless Backyard Barbell and Fitness Club, LLC, their principals, agents, employees and volunteers from liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in activities offered by Backyard Barbell and Fitness Club, LLC, at the main building or abroad. This includes but is not limited to parks, recreational areas, playgrounds, areas adjacent to the main building, and/or any area selected for training by Backyard Barbell and Fitness Club, LLC, their principals, agents, employees and volunteers. I hereby consent to receive medical treatment which may be deemed advisable in event of injury, accident and/or illness during this activity. If I am signing of the behalf of a minor child, I also give full permission for any person connected with Backyard Barbell and Fitness Club, LLC to administer first aid deemed necessary for the wellbeing of the child. I understand that I may be photographed while at Backyard Barbell and Fitness Club, LLC. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose without compensation, on the Backyard Barbell and Fitness Club, LLC website, or in any editorial promotional or advertising material produced and/or published by Backyard Barbell and Fitness Club, LLC

I Understand.

TODAYS DATE *

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