Waiver, Release, and Assumption of Risk
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This form is an important legal document. It explains the risks you are assuming by participation in an exercise program with Dusten Brunner and/or any member of Brunner Athletic Development and Health Fitness. It is important that you read and understand it completely. After you have done so, please type in your name. Typing your name in the box is the same as your signature on this document. If you are under the age of 18 it will be required to have a paper format document signed by the parent or guardian of the individual. *

Waiver, Informed Consent, and Covenant Not to Sue

I have volunteered to participate in physical exercise under the direction of Brunner Athletic Development & Health Fitness, which will include, but may not be limited to, weight and/or resistance training. In consideration of Brunner Athletic Development & Health Fitness’s agreement to instruct, assist, and train me, I do here and forever release and discharge and hereby hold harmless Mr. Dusten Brunner, and his respective agents, heirs, assigns, contractors, and employees from any and all claims, demands, damages, rights of action or causes of action, present or future, arising out of or connected with my participation in this or any exercise program including any injuries resulting there from. THIS WAIVER AND RELEASE OF LIABILITY INCLUDES, WITHOUT LIMITATION, INJURIES WHICH MAY OCCUR AS A RESULT OF (1) EQUIPMENT THAT MAY MALFUNCTION OR BREAK (2) ANY SLIP, FALL, DROPPING OF EQUIPMENT AND (3) OUR NEGLIGENT INSTRUCTION OR SUPERVISION. 

Assumption of Risk

I recognize that exercise might be difficult and strenuous and that there could be dangers inherent in exercise for some individuals. I acknowledge that the possibility of certain unusual physical changes during exercise does exist. These changes include abnormal blood pressure; fainting; disorders in heartbeat; heart attack; and, in rare instances, death. I understand that as a result of my participation, I could suffer an injury or physical disorder that could result in my becoming partially or totally disabled and incapable of performing any gainful employment or having a normal social life. I recognize that an examination by my physician must be obtained prior to involvement in this exercise program. I acknowledge and agree that I assume the risks associated with any and all activities and/or exercises in which I participate. 

I ACKNOWLEDGE THAT I HAVE THOROUGHLY READ THIS WAIVER AND RELEASE AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. BY SIGNING THIS DOCUMENT, I AM WAIVING ANY RIGHT I OR MY SUCCESSORS MIGHT HAVE TO BRING A LEGAL ACTION OR ASSERT A CLAIM AGAINST MR. DUSTEN BRUNNER or OTHERS REFERRED TO IN THIS DOCUMENT FOR ANY NEGLIGENCE OR THAT OF OUR EMPLOYEES, AGENTS, OR CONTRACTORS.  

Photography and Audio/Video Recording

I hereby give Brunner Athletic Development & Health Fitness permission to video tape, photograph, and record my image and or likeness. I understand that such taping or recording may be used at the sole discretion of Brunner Athletic Development & Health Fitness. I also understand by giving permission is in no way an endorsement of Brunner Athletic Development & Health Fitness or any product(s) distributed by Brunner Athletic Development & Health Fitness.
     
 
Participant's Signature (parent/guardian if under 18) *

 
Date *

 
Phone Number *

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