Health + Liability Waiver

First Name

Last Name

Please provide the name and phone number of an emergency contact

Signature

I declare that the info I’ve provided is accurate & complete

I hereby acknowledge this release from liability for accidental injury or illness which I may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.

In exchange for participation in the activity of Fitness classes organized by Sheena Allen (“The Firm Savannah”), of 903 East 70th St. Savannah,Ga. 31405 and/or use of the property, facilities and services of Sheena Allen, I agree for myself and (if applicable) for the members of my family, to the following: 1. I agree to observe and obey all posted rules and warnings and further agree to follow any oral instructions or directions given by Sheena Allen or the employees, representatives or agents of Sheena Allen. 2. I recognize that there are certain inherent risks associated with the above described activity and I assume full responsibility for personal injury to myself and (if applicable) my family members and further release and discharge Sheena Allen for injury, loss or damage arising out of my or my family’s use of or presence upon the facilities of Sheena Allen whether caused by the fault of myself, my family, Sheena Allen or other third parties. 3. I agree to indemnify and defend Sheena Allen against all claims, causes of action, damages, judgments, cost or expenses, including attorney fees and other litigation costs, which may in any way arise from my or my family’s use of or presence upon the facilities of Sheena Allen. 4. I agree to pay for all damages to the facilities of Sheena Allen caused by my or my family’s negligent, reckless or willful actions. 5. Any legal or equitable claim that may arise from participation in the above shall be resolved under Georgia law.

I acknowledge the contagious nature of Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing and wearing face coverings. I further acknowledge and agree that The Firm Gym[1] has put in place reasonable preventative measures to reduce the spread of Coronavirus/COVID-19 and other viruses and illnesses. I further acknowledge and agree that The Firm Gym cannot guarantee that I will not become exposed to or infected with Coronavirus/Covid-19 or any other virus or illness while using The Firm Gym facilities or equipment. I understand and agree that the risk of exposure to Coronavirus/COVID-19 and other viruses and illnesses is inherent and unavoidable with regard to the activity of visiting and working out in a gym or similar facility. I understand and agree that this risk may result from the actions, omissions, or negligence of myself and/or others, including, but not limited to, The Firm Gym staff, members, clients, guests, and others using or visiting The Firm Gym facilities. I voluntarily seek services provided by The Firm Gym and acknowledge that by doing so I am increasing my risk of exposure to Coronavirus/COVID-19 and other viruses and illnesses. I acknowledge that I must comply with procedures to reduce the spread or Coronavirus/COVID-19 and other viruses and illnesses at any The Firm Gym facility. • For my protection and the protection of others , in consideration of being granted access to The Firm Gym facilities and equipment, and knowing that The Firm Gym and its staff, members, clients, guests, and others will act in reasonable reliance on the truth of my statements herein, I represent, warrant, and attest that: • I am not experiencing any symptom of illness, including but to limited to cough, shortness of breath or difficulty breathing, fever, chills, shaking, muscle pain, headache, sore throat, or loss of taste or smell. • I have not traveled internationally within the last 14 days. • I have not traveled to a highly impacted area within the United States of America in the last 14 days. • I have not been exposed to anyone with a suspected and/or confirmed case of Coronavirus/COVID-19 or any other contagious disease or illness in the last 14 days. • I have not been diagnosed with Coronavirus/Covid-19 or any other contagious disease or illness (unless I have also been cleared as non-contagious by public health authorities after being so diagnosed). • I have been following and will continue to follow all applicable guidelines relating to the prevention of disease and prevention of the spread of disease issued by the CDC and by the public health departments/officers of the cities, counties and states in which I work, live, and visited within the past 14 days, and in which the The Firm Gym facilities which I use are located. • On behalf of myself, my family members, my heirs, representatives, and successors, I hereby willfully and voluntarily acknowledge and accept the risks of being present at and using The Firm Gym facilities and equipment and being near others using The Firm Gym facilities and equipment, and to the maximum extent permitted by law release and agree t

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