Waiver Form - Wonders Counseling (Page 2 of 2) in pdf

5. I hereby, for myself and for my heirs, next of kin, executors, administrators and assigns, fully release, waive and forever discharge any and all

rights or Claims I may have, now or in the future, against any Released Party, even if the Claims are based on the carelessness, negligence or gross

negligence of a Released Party or anyone else. Without limiting the foregoing, I further release any recourses which I may now or hereafter have

resulting from any decision of any Released Party.

6. I agree not to sue any Released Party for Claims, even if the Claims arise from the carelessness, negligence or gross negligence of any Released

Party or anyone else. I agree to indemnify (reimburse for any loss) and hold harmless each Released Party from any loss or liability (including any

reasonable legal fees they may incur) defending any Claim made by me or anyone making a Claim on my behalf, even if the Claim is alleged to or

did result from the carelessness or negligence of any Released Party or anyone else.

7. I am aware that there is no obligation for any person to provide me with medical care during the Activity. I understand and acknowledge that:

a. there may be no aid stations available for the Activity.

b. if medical care is rendered to me, I consent to that care if I am unable to give my consent for any reason at the time the care is rendered.

8. I am aware that it is advisable to consult a physician prior to participating in the Activity. If I have consulted a physician, I have taken the

physician’s advice.

9. I grant my permission to the Released Party and any transferee or licensee or any of them, to utilize any photographs, motion pictures,

videotapes, recordings and other references or records of the Activity which may depict, record or refer to me for any purpose (“Likeness”),

including commercial use by the released parties, their sponsors and their licensees. This permission is for use anywhere in the world and on the

Internet and for an unlimited period of time. I understand and agree that I will not be compensated or receive additional consideration for

consenting to the use of my Likeness and that I will not be given a chance to receive, inspect or approve the promotional or marketing material,

messages and/or content that may use my Likeness.

10. No warranties or representations have been made to me about the Activity which are not stated on this form. I understand and intend that this

document act as the broadest and most inclusive assumption of risk, waiver, release of liability, agreement not to sue and indemnity.

11. If any provision of this agreement shall be unlawful, void or for any reason unenforceable, then that provision shall be deemed severable from

this agreement and shall not affect the validity and enforceability of any remaining provisions.

12. I have fully read and understand this agreement. I am aware that by signing this agreement, I am waiving certain legal rights I or my heirs, next

of kin, executors, administrators and assigns may have against the Released Party.

13. I hereby acknowledge that I may be required to use an automobile to travel to and from the Activity or as part of the Activity. I hereby

acknowledge that I have the authority to use such automobile and that the automobile is fully insured for use in the Activity. I accept full

responsibility for the automobile and that use of the automobile in the Activity will be at my own risk.

I also understand that (please initial);

______ All payments are non-refundable or transferrable for any reason, including, but not limited to vacation, illness and injury.

______ The scheduling and content of activities may be changed on occasion.

______ All N.S.F. cheques will be charged a $30.00 (CDN) fee.

______ I will notify my instructor immediately of any pain and/or major discomfort felt during any activity.

______ I am responsible for bringing my required equipment to every activity (where applicable).

______ If I am pregnant or plan to become pregnant during course of the Activity, I will submit a ParMED-X for Pregnancy, a guideline for health

screening prior to participation in a fitness class.

BY SIGNING BELOW, Participant accepts and agrees to the terms and provisions contained in this agreement.

___________________________ ____________________

Signature

_______________________ ________________________

Date

Waiver Form - Wonders Counseling Page 2