I, , have volunteered to participate in a fitness/coaching program provided to me by Courtenay Fitness, LLC (“Trainer/Coach”), which may include, but may not be limited to, resistance training and aerobic or cardiovascular exercise. In consideration of Trainer/Coach agreement to instruct and train me, I do here now and forever release and discharge and hereby hold harmless Trainer and his 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 BELONGING TO TRAINER OR TO MYSELF THAT MAY MALFUNCTION OR BREAK; (2) ANY SLIP, FALL, DROPPING OF EQUIPMENT; (3) AND/OR NEGLIGENT INSTRUCTION OR SUPERVISION.
I, , have been informed of, understand and am aware that any exercise program, whether or not requiring the use of exercise equipment, is a potentially hazardous activity. I also have been informed of, understand and am aware that any exercise and/or fitness activities involve a risk of injury, as well as abnormal changes in blood pressure, fainting, and a remote risk of heart attack, stroke, other serious disability or death, and that I am voluntarily participating in these activities and using equipment and machinery with full knowledge, understanding and appreciation of the dangers involved. I hereby agree to expressly assume and accept any and all risks of injury, regardless of severity, or death. I have been advised that an examination by a physician should be obtained by anyone prior to commencing a fitness and/or exercise program, or initiating a substantial change in the amount of regular physical activity performed.
If I, , have chosen not to obtain a physician’s consent prior to beginning this fitness program with Trainer, I hereby agree that I am doing so solely at my own risk. In any event, I acknowledge and agree that I assume the risks associated with any and all fitness related activities and/or exercises in which I participate.
I, , agree to allow Courtenay Fitness, LLC; to design a weight management program for me to enhance my health and fitness goals. I will follow that program to the best of my ability and I will not hold Courtenay Fitness, LLC or any one related persons or parties personally liable for any problems, illnesses or injuries that may occur due to a sudden change in my eating habits. I understand that Courtenay Fitness, LLC is not a registered or licensed dietician, nor a medical practitioner. This weight program does not replace the expert advice or medical treatment of my own private doctor. I have given Courtenay Fitness, LLC all necessary information about myself to prevent any possible complications. The service to be provided is coaching, which is not advice, therapy, nor counseling and may address specific personal projects, business successes or general conditions in the client’s life or profession. Coaching is a designed alliance that helps bring out the best in the client and helps the client create and live the life they want to live.
The coach promises the client that all information provided to the coach will be kept strictly confidential as allowed by law. Throughout the working relationship the coach will engage in direct and personal conversations. The client can count on the coach to be honest and straightforward in asking questions and making requests. The client understands that the power of the coaching relationship can only be granted by the client and the client agrees to do just that—have the coaching relationship to be powerful. If the client believes that coaching is not working as desired, the client will immediately communicate that to the coach and both will take action to remedy the situation.
I, , hereby certify that I do not suffer from any physical or mental disability that might affect my participation in the coaching process, and, if I have any substance abuse problem or mental illness, I have consulted with my physical and other health care professional and been advised that I may participate in the coaching process without risk. I agree that if there is any change in this representation, I will promptly advise the coach.
I, , the undersigned (“the purchasers”) hereby warrants that I will indemnify and hold harmless Courtenay Fitness ,LLC, known hereafter as (“the sellers”), and its officers, directors, agents, and employees. This indemnification and hold harmless warranty extends to sellers, individually and separately, and, the corporation’s successors, and subsidiaries, as against an and all claims, demands, actions, and causes of action, including personal injury, and all other liability whatsoever, including but not limited to, costs, attorney’s fees and/or judgments which arise out of the use of Courtenay Fitness, LLC fitness/coaching program.
(Disregard the below portion if you have Already Paid in Full)
PAYMENTS: First payment will be debited on start of the program with future payments approximately on the same day each month (every 30 days) thereafter until completion / termination of training program. All programs will renew automatically after the first month of the program on a month to month basis with same monthly rate, unless Client gives notice of program termination by phone only at 917-709- 7511 at least 14 days from the next debit date. If contract is cancelled before the term is over (3 month, 6 month or 12 month agreement) there will be a $199.00 early cancellation fee charged to the clients card.
EFT Payment Authorization: Client hereby authorizes Trainer or its assigns to make periodic charges or withdrawals (“Electronic Funds Transfer Authorization”) from my account as listed below for the payment of any and all fees, expenses or any other monies due Trainer. Client waives the right to receive prior notice for charges of withdrawals made with respect to any uncollected payments or portions of the balance due described below and the corresponding service charge.
I ACKNOWLEDGE THAT I HAVE THOROUGHLY READ THIS FORM IN ITS ENTIRETY 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 TRAINER FOR YOUR NEGLIGENCE OR THAT OF YOUR EMPLOYEES, AGENTS, OR CONTRACTORS.
This form is an important legal document that explains the risks you are assuming by beginning an exercise/coaching program. It is critical that you have read and understand this document completely. If you do not understand any part of this document, it is your ultimate responsibility to ask for clarification prior to signing it.
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