
All individuals participating in open gyms, programs, leagues, lessons, performance training, workout sessions/classes are required to have a signed wavier on file
RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT (“Agreement”)
In consideration of being permitted to be present at, attend, observe, and participate in activities at the facilities of, or provided by, Impact Athletic Center, Inc. and Litchfield Holdings, LLC. (the "Activities") I, for myself and for my child(ren) (collectively referred to herein as “me” “I” or “my”), personal representatives, assigns and heirs:
RELEASE (FOR PARTICIPANTS AGED 18 AND OVER)
I HAVE READ THIS AGREEMENT AND FULLY UNDERSTAND AND AGREE TO BE BOUND BY ITS TERMS. I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL LEGAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUT INDUCEMENT OR ASSURANCE OF ANY NATURE.
Printed Name of Participant: ______________________________________
Address: __________________________________________
_________________________________________________
Email Address _____________________________________
Phone: ___________________________________________
Participant’s Signature (18 or over): _____________________________________________________
Date:
_____________________________
MINOR RELEASE (FOR PARTICIPANTS UNDER THE AGE OF 18)
BY SIGNING ON BEHALF OF A MINOR CHILD PARTICIPANT, I REPRESENT THAT I AM THAT MINOR CHILD’S PARENT OR LEGAL GUARDIAN, THAT I AM AUTHORIZED TO SIGN THIS AGREEMENT ON THE MINOR CHILD’S BEHALF, AND AGREE THAT I WILL DEFEND, INDEMNIFY, AND HOLD HARMLESS RELEASEES AGAINST ANY CLAIMS ARISING FROM THE MINOR PARTICIPANT’S PRESENCE AT IMPACT ATHLETIC CENTER OR PARTICIPATION IN THE ACTIVITIES. I ACKNOWLEDGE THAT THE MINOR PARTICIPANT IS BOUND BY ALL THE TERMS OF THIS AGREEMENT AND UNDERSTAND THAT THE MINOR PARTICIPANT WOULD NOT BE PERMITTED TO BE AT IMPACT ATHLETIC CENTER, INC. OR TAKE PART IN THE ACTIVITIES UNLESS I AGREE TO ALL TERMS OF THIS AGREEMENT.
Printed Name of Participant: ____________________________________________
Printed Name of Parent/Guardian: _______________________________________
Address: ____________________________________
___________________________________________
Email Address: _______________________________________
Phone: _____________________________________________
PARENT/GUARDIAN SIGNATURE: _____________________________________________________
Date: _____________________________