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FMT Waiver
Home
Grief Education
Events
About
Cupping
Contact
FMT Waiver
Electronic Waiver
Please complete the form below.
Name
*
First Name
Last Name
Email
*
Telephone
*
Cell and/or Home
Emergency Contact
*
Name and Phone Number
Liability Waiver
*
I, the undersigned, being aware of my own health and physical condition, acknowledge that my participation in any fitness activity, class or personal training may be injurious to my health and physical body, am voluntarily participating in a physical fitness activity. Having such knowledge, I hereby acknowledge this release any representatives, agents, and successors including LeeAnn Freymond and LeeAnn Freymond Functional Fitness, from liability for injury or illness as a result of participating in the said fitness activity. I hereby assume all risks connected therewith and consent to participate in said activity, class or training. I agree to disclose any physical limitations, disabilities, ailments, impairments, injuries, surgeries, medical procedures, allergies, illness or condition which may affect my ability to participate in said fitness activity. ASSUMPTION OF RISKS. I understand that while LeeAnn Freymond Functional Fitness has undertaken reasonable steps to lessen the risk of transmission of COVID-19 in connection with the Services, LeeAnn Freymond Functional Fitness is not responsible in any manner for any risks related to COVID-19 in connection with the Services. I understand that the World Health Organization has classified the COVID-19 outbreak as a pandemic. I further understand that COVID-19 is a highly contagious and dangerous disease, and that contact with the virus that causes COVID-19 may result in significant personal injury or death. I am fully aware that participation in the Services (including any related travel) carries with it certain inherent risks related to COVID-19 transmission (“Inherent Risks”) that cannot be eliminated regardless of the care taken to avoid such risks. Inherent Risks may include, but are not limited to, (1) the risk of coming into close contact with individuals or objects that may be carrying COVID-19; (2) the risk of transmitting or contracting COVID-19, directly or indirectly, to or from other individuals; and (3) injuries and complications ranging in severity from minor to catastrophic, including death, resulting directly or indirectly from COVID-19 or the treatment thereof. Further, I understand that the risks of COVID-19 are not fully understood, and that contact with, or transmission of, COVID-19 may result in risks including but not limited to loss, personal injury, sickness, death, damage, and expense, the exact nature of which are not currently ascertainable, and all of which are to be considered Inherent Risks. I hereby voluntarily accept and assume all risk of loss, personal injury, sickness, death, damage, and expense arising from such Inherent Risks. Furthermore, I represent and warrant that I do not suffer from any medical condition or disease that might in any way hinder or prevent me from receiving the Services, including, to my knowledge, COVID-19.
I agree
Signature
*
Type your name or first and last initials
Please list any physical limitations or health conditions that might impact your ability to participate in classes or personal training sessions:
Thank you!