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Waiver, Release, and Assumption of Risk Form:
This form is an important legal document. It explains the risks you are assuming by participation in a strength and conditioning program. It is important that you read this entire document and understand it completely. After you have done so, please sign in the space provided at the bottom. If you are under the age of 18, a parent/guardian will need to sign.
WAIVER, INFORMED CONSENT, AND COVENANT NOT TO SUE:
I have agreed to participate in strength and conditioning services provided by the Boston Sports Performance Center, their agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as “BSPC”), which will include, but may not be limited to, weight and/or resistance training. I acknowledge that my participation in fitness training activities entails known and unanticipated risks that could result in physical or emotional injury, paralysis, death, or damage to myself, to property, or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity, and acknowledge that such risks may include, among other things: slips and falls; collision with fixed objects or people; muscular strains and tears, sprains, cuts, bruises, fractured bones, organ damage, and nerve damage; muscle soreness; musculoskeletal injuries including head, neck, and back; injuries to internal organs; dehydration; permanent disability; the possibility of eye damage or loss of hearing; the failure to work out safely or within one’s own ability or within designated area; the negligence of other participants or persons who may be present; emotional and psychological injuries; my own physical condition, and the physical exertion associated with this activity.
Accordingly, in consideration of such services, I do here and forever release and discharge and hereby hold harmless BSPC, Steward Medical Group, Inc., and their 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) BSPC’S 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, including, without limitation, all such injuries described above.
I recognize that an examination by my physician must be obtained prior to involvement in this exercise program.
I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks.
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 BPSC OR OTHERS REFERRED TO IN THIS DOCUMENT FOR ANY NEGLIGENCE OR THAT OF OUR EMPLOYEES, AGENTS, OR CONTRACTORS.
I hereby consent to and authorize photographs, recordings and quotes written, visual, and audio, to be taken by or on behalf of Steward Health Care during care and treatment at a Steward Health Care facility or at a sponsored event.
I understand that any information generated from any inerview, or photography and recordings may be included in publications on behalf of Steward (including newspapers, television, journals, websites, social media or other). I am aware that Steward may use my information from any interviews, photographs or recordings for public relations and/or media coverage. I am further aware that Steward cannot control the further use and disclosure of such information once it was been released to the media or general public.
I understand that this authorization shall remain in effect until I revoke it. I may revoke this authorization by providing written notice to Steward Health Care Marketing Department, 1900N. Pearl Street, Suite 2400, Dallas TX 75201.
I hereby release Steward their members, trustees, agents servants and employees and members to their medical staff from any and all claims arising this authorization.
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