Membership Application - Ymca Of Northwest North Carolina (Page 3 of 3) in pdf

RELEASE and WAIVER of LIABILITY and INDEMNITY AGREEMENT

In consideration for being permitted to utilize the facilities, services, and programs of the YMCA of Northwest North Carolina (hereafter “YMCA”) for any

purpose, including but not limited to observation or use of facilities or equipment, or participation in any program affiliated with the YMCA, without respect

to location, the undersigned, for himself or herself and any personal representatives, heirs, and next of kin, hereby acknowledges, agrees and represents that

he or she has, or immediately upon entering or participating will inspect and carefully consider such premises and facilities or the affiliated program. It is

further warranted that such entry into the YMCA for observation or use of any facilities or equipment or participation in such affiliated program constitutes

an acknowledgment that such premises and all facilities and equipment thereon and such affiliated programs have been inspected and carefully considered

and that the undersigned finds and accepts same as being safe and reasonably suited for the purpose of such observation, use, or participation. The YMCA

prohibits membership by persons required to register in the North Carolina Sex Offender and Public Protection Registry. All still and video photography taken

by YMCA staff or agents for the expressed purpose of marketing the YMCA, its programs, or membership is property of the YMCA. IN FURTHER

CONSIDERATION OF BEING PERMITTED TO ENTER THE YMCA FOR ANY PURPOSE, INCLUDING BUT NOT LIMITED TO OBSERVATION OR USE OF FACILITIES OR

EQUIPMENT, OR PARTICIPATION IN ANY PROGRAM AFFILIATED WITH THE YMCA, WITHOUT RESPECT TO LOCATION, THE UNDERSIGNED HEREBY AGREES TO

THE FOLLOWING:

THE UNDERSIGNED HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE the YMCA, it’s directors, officers, employees, and

agents (hereinafter referred to as “releasees”) from all liability to the undersigned, his personal representatives, assigns, heirs, and next of kin for

any loss or damage, and any claim or demands therefore on account of injury to the person or property or resulting in death of the undersigned,

whether caused by the premises or any facilities or equipment therein, or participating in any program affiliated with the YMCA, without respect to

location.

THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releasees and each of them from any loss, liability,

damage, or cost they may incur due to the presence of the undersigned in, upon, or about the YMCA premises or in any way observing or using any

facilities or equipment of the YMCA or participating in any program affiliated with the YMCA whether caused by the negligence of the releasees or

otherwise.

THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH, OR PROPERTY DAMAGE due to negligence

of releasees or otherwise while in, about, or upon the premises of the YMCA and/or while using the premises or any facilities or equipment thereon

or participating in any program affiliated with the YMCA.

THE UNDERSIGNED further expressly agrees that the forgoing RELEASE, WAIVER AND INDEMNITY AGREEMENT is intended to be as broad and inclusive as is

permitted by the law of the State of North Carolina and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding,

continue in full legal force and effect.

THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agrees that no

oral representations, statements, or inducement apart from the foregoing written agreement have been made.

I HAVE READ THIS RELEASE

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Date

Participant’s Signature

Date

Parent’s or Guardian’s Signature

(if participant is legally a minor)

RELEASE from INDEMNITY - FITNESS and EXERCISE ORIENTATION

I have been offered and urged to attend an equipment orientation at the YMCA of Northwest North Carolina before using any equipment or beginning any

exercise. I have been urged to consult with my physician for a physical to determine any health risks associated with my exercising.

I desire to voluntarily waive an equipment orientation at the YMCA of Northwest North Carolina and to waive any explanations concerning the risks of use of

the equipment or of my exercising. I understand that the exercise will place an increasing workload on my cardiorespiratory and musculoskeletal systems and

there is a risk of physical changes during or following my exercise. I understand that failure to use the equipment properly may result in injury, illness, or

medical problems including but not limited to fractured or broken bones, strained or torn muscles, tendons, or ligaments, dizziness, feeling light-headed or

becoming faint, stroke, heart attack, joint problems, or other physical problems.

I understand that I am responsible for monitoring my own condition throughout the exercise program and should any unusual symptoms occur, I will cease my

participation and inform the fitness instructor, another YMCA professional staff member, or the Welcome Center attendant.

I certify that I have no physical condition which would prevent me from safely engaging in an exercise program and agree to abide by all the rules and

regulations of the YMCA.

In consideration for being allowed to participate in the YMCA of Northwest North Carolina exercise program, I agree to assume the risk of such exercise and

inherent dangers from exercise and use of the equipment. I hereby release the YMCA of Northwest North Carolina and its staff members from any and all

claims, suits, losses, or related causes of action for damages related to my exercise program and hold them harmless from anything arising therefrom.

In signing this release and consent form, I affirm that I am legally capable of so acting, that I have read this form in its entirety, that I understand the nature

of the exercise program, and that I do not want further information. All the questions I have concerning the exercise program or the equipment have been

answered to my satisfaction.

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Printed Name of participant

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Signature of Participant

Date

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Signature of YMCA Witness

Date

Our Mission: Helping people reach their God-given potential in spirit, mind, and body.