Jay Roc & Porscha
Local to Greensboro? Visit Us!
Smile Inside Out
Free Wellness Call
Products & Services
Customized Fitness Programs
A Guide to a New You
Earn Extra Income
3 Day Refresh
Fit Camp Waiver
Please Read and Fill-in the blanks, Check Each Box to Proceed to the Next Page
Check this box if you've selected 1-on-1 training. If not, please continue to the waiver.
In consideration of my use of the exercise equipment and facilities provided by Alpha Nutrition, LLC, dba The Healthy Shape, I expressly agree and contract, on behalf of myself, my heirs, executors, administrators, successors and assigns, that Alpha Nutrition, LLC, dba The Healthy Shape and its insurers, employees, officers, directors, and associates, shall not be liable for any damages arising from personal injuries (including death) sustained by me, or my guest in, on, or about the premises, or as a result of the use of the equipment or facilities, regardless of whether such injuries result, in whole or in part, from the negligence of Alpha Nutrition, LLC, dba The Healthy Shape.
By the execution of this agreement, I accept and assume full responsibility for any and all injuries, damages (both economic and non-economic), and losses of any type, which may occur to me or my guest, and I hereby fully and forever release and discharge Alpha Nutrition, LLC, The Healthy Shape, its insurers, employees, officers, directors, and associates, from any and all claims, demands, damages, rights of action, or causes of action, present or future, whether the same be known or unknown, anticipated, or unanticipated, resulting from or arising out of the use of said equipment and facilities.I expressly agree to indemnify and hold Alpha Nutrition, LLC, dba The Healthy Shape harmless against any and all claims, demands, damages, rights of action, or causes of action, of any person or entity, that may arise from injuries or damages sustained by me or my guest.
I agree to be solely responsible for the safety and well being of my guest and myself. I understand that Alpha Nutrition, LLC, dba The Healthy Shape does not provide supervision, instruction, or assistance for the use of the facilities and equipment.I agree to comply with all rules imposed by Alpha Nutrition, LLC, dba The Healthy Shape regarding the use of the facilities and equipment. I agree to conduct myself in a controlled and reasonable manner at all times, and to refrain from using any equipment in a manner inconsistent with its intended design and purpose.
I understand and acknowledge that the use of exercise equipment involves risk of serious injury, including permanent disability and death.I understand and agree that Alpha Nutrition, LLC, dba The Healthy Shape is not responsible for property that is lost, stolen, or damaged while in, on, or about the premises.I understand and agree that my use of the facilities and equipment is only to be undertaken on my own personal time, and that my use of the facilities and equipment is not within the course or scope of my employment.
I understand and acknowledge the 24 hour cancellation and rescheduling policy: 24 hour notice is required to cancel or reschedule appointments. Failure to do so will result in forfeiting your session. Late cancellation and/or reschedules are subject to a rescheduling fee.
Page 2 of 3