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Waiver:
In consideration of mindbodybaby, LLC providing services to me, on behalf of myself, my
heirs, personal representatives, or assigns, I do hereby release, waive, discharge, and covenant not to sue mindbodybaby,
LLC, its owners, officers, employees, volunteers, agents and contractors, from liability from any and all claims arising from
the ordinary negligence of mindbodybaby, LLC or any of the aforementioned parties.
This agreement applies to 1) personal
injury (including death) from accidents or illnesses arising directly or indirectly from participation in activities directed,
suggested, or planned by mindbodybaby, LLC including, but not limited to, organized activities, classes, instruction, observation,
related activities in a non-supervised setting and use of facilities, premises, or equipment; and to 2) any and all claims
resulting from the damage to, loss of or theft of property. Indemnification and Hold Harmless:
I also agree to hold harmless and indemnify mindbodybaby, LLC, its owners, officers, employees, volunteers, agents, contractors
and insurance carriers from all claims (whether initiated by me or by a third party) and to reimburse them for any expenses
incurred as a result of my involvement with mindbodybaby, LLC. I further agree to pay all expenses, including court costs
and attorneys' fees, incurred by mindbodybaby, LLC and the aforementioned parties in investigating and defending a claim or
suit resulting from my participation in any mindbodybaby, LLC fitness and conditioning activities. Severability
and Venue:
I further expressly agree that the foregoing waiver and assumption of risk agreement is intended to be as
broad and inclusive as is permitted by the law of the Commonwealth of Massachusetts and that if any portion thereof is held
invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. Likewise, I agree
that if legal action is brought, it must be brought in the District Court or the Federal Court residing where the incident
occurred.
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Description of mindbodybaby Program and Potential Risks:
I understand and do hereby consent to participate
in a fitness training program that will include resistance training, plyometrics, stretching and/or cardiovascular exercises.
I have been informed and understand that physical exercise has been associated with certain risks, including but not limited
to occasional minor injuries (e.g. pulled muscles, muscle soreness, musculo-skeletal strains and sprain, bruises) to infrequent
serious injury (e.g., heart attack, stroke or other cardiovascular accidents, muscle tears) to the very rare catastrophic
incident (e.g., death, paralysis). I acknowledge that regardless of the care taken by my trainers that he or she cannot guarantee
my personal safety. mindbodybaby Participant Responsibilities:
I understand it is my responsibility
to 1) fully disclose any health issues (including diabetes, heart problems, seizures, and asthma) or medications that are
relevant to participation in a strenuous exercise program; 2) inform the trainer if there are changes to my health, including
injuries and sickness 3) inform the trainer if there are activities with which I do not feel comfortable; 4) cease exercise
and report promptly any unusual feelings (e.g., chest discomfort, nausea, difficulty breathing, apparent injury) during the
exercise program; and 5) clear my participation with my physician. mindbodybaby Participant Acknowledgments:
In agreeing to this exercise program, I, the participant 1) acknowledge that my participation is completely voluntary; 2)
understand the potential physical risks involved in the exercise program and believe that the potential benefits outweigh
those risks; 3) give consent to certain physical touching that may be necessary to ensure proper technique and body alignment;
4) understand that the achievement of health or fitness goals cannot be guaranteed; 5) have been able to ask questions regarding
any concerns I might have, and have had those questions answered to my satisfaction; 6) am in good physical condition, have
no impairment which might prevent my participation in such activities, and have been advised to consult a physician prior
to beginning this program; 7) have been advised to cease exercise immediately if I experience unusual discomfort and feel
the need to stop.
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If you answer YES to any of the following questions, please speak with your physician about any implications
of becoming more physically active by participating in mindbodybaby, LLC programming. - Are
you a man over the age of 45 or a woman over the age of 55? Do you have a heart condition?
- Do
you ever feel pains in your chest? Do you easily loose your balance, get dizzy or loose consciousness while either sedentary
or active?
- Do you have a bone, muscle or joint problem that could be made worse by becoming
more physically active?
- Are you currently taking drugs for blood pressure, cholesterol, diabetes,
or heart conditions?
- Are cardiovascular risks (diabetes, heart disease, high blood pressure
or cholesterol) present in your immediae family?
- If you are female, are you currently pregnant
or have recently given birth?
- Do you have chronic pain?
- Are
you currently sedentary?
- Are there any other issues, concerns, or special circumstances that
may increase the risk of injury or harm to you, other participants or instructor as a result of your participation in the
mindbodybaby, LLC programming?
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WAIVER & CONTACT INFORMATION
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