American University'S Recreational Sports And Fitness Registration Form Page 3
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4Recreational Sports and Fitness
Agreement and Release of Liability
1. In consideration of gaining membership or being allowed to participate in the activities and programs of the Fitness Center and to
use its facilities, equipment, and machinery in addition to the payment of any fee or charge, I do hereby for myself, my heirs,
executors, administrators and assign, waive, release, and forever discharge American University and its officers, agents, employees,
representatives, executors, and all others from any and all responsibilities or liability for injuries or damages resulting from my
participation in any activities or my use of equipment or machinery in the above-mentioned facilities or arising out of my participation
in any activities at said facility. I do also hereby release all of those mentioned and any others acting upon their behalf from any
responsibility or liability for any injury or damage to myself, including those caused by the negligent act or omission of any of those
mentioned or others acting on their behalf or in any way arising out of or connected with my participation in any activities of the
Fitness Center or the use of any equipment at the Fitness Center. (Please initial ________ )
2. I understand and am aware that strength, flexibility, and aerobic exercise, including the use of equipment, is a potentially hazardous
activity. I also understand that fitness activities involve a risk up to and including death and that I am voluntarily participating in these
activities and using equipment and machinery with knowledge of the dangers involved. I hereby agree to expressly assume and accept
any and all risk of injury and/or death. (Please initial______ )
3. I do hereby further declare myself to be physically sound and suffering from no condition, impairment, disease, infirmity, or other
illness that would prevent my participation in any of the activities and programs of the Fitness Center or use of equipment or
machinery except as hereinafter stated. I do hereby acknowledge that I have been informed of the need for a physician’s approval for
my participation in an exercise/fitness activity or in the use of exercise equipment and machinery. I also acknowledge that it has been
recommended that I have a yearly or more frequent physical examination and consultation with my physician as to physical activity,
exercise, and use of exercise and training equipment so that I might have recommendations concerning these fitness activities and
equipment use. I acknowledge that I have either had a physical examination and have been given my physician’s permission to
participate, or that I have decided to participate in activity and/or use of equipment and machinery without the approval of my
physician and do hereby assume all responsibility for my participation and activities, and utilization of equipment and machinery in
my activities. (Please initial _________ )
4. I absolve, indemnify, defend and hold harmless American University from any breach of these representations. (Please initial
_______ )
5. I hereby consent to and permit emergency treatment in the event of illness or injury while participating in the activities and
programs of the Fitness Center.
(Please initial _______ )
I have read and understand the above provisions and agree to be bound by them, as indicated by
my signature below.
Signature________________________
Legal Guardian Signature___________________
(under 18 years old only)
Printed Name_____________________
Print Name_______________________________
Date____________________________
Date____________________________________
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