Acknowledgement and Release of Liability

I request authorization for me to use the Sarah Carr Psychological Services Fitness Room. I acknowledge that the use of the Fitness Room is expressly conditioned on my agreement to each of the terms of this document. I acknowledge and agree as follows: 

1. Use of The Sarah Carr Psychological Services Fitness Room involves physical exercise activities that may cause injury. I understand that there is an inherent risk of injury when choosing to participate in any physical exercise activity. My use of the Fitness Room is a voluntary activity in all respects and I assume all risks of injury and illness that may result from such use. This includes any group activities or individual use of the Fitness Room or exercise equipment. 

2. As the participant, I recognize and acknowledge that there are risks of physical injury and I agree to assume the full risk of any injuries (including death), damages, or loss which I may sustain as a result of participating in any and all activities arising out of, connected with or in any way associated with my use of the Fitness Room. I acknowledge that participation and use of the Fitness Room is voluntary. 

3. I, on behalf of myself, do hereby fully release and discharge The Sarah Carr Psychological Services and their agents, their successor and assigns, employees and all associated persons, and those whose facilities are being used for this program (collectively, the “Released Parties”) from any and all liability, claims, and causes of action from injuries or illness (including death), damages or loss which I may have or which may accrue to me on account of participation in all activities utilizing the Fitness Room. This is a complete and irrevocable release and waiver of liability. Specifically and without limitation, I, on behalf of myself, hereby release the Released Parties from any liability, claim, or cause of action arising out of the Released Parties' negligence. I, on behalf of myself, agree not to sue the Released Parties for any alleged liabilities, claims, or causes of action released hereunder. 

4. I further agree to indemnify and hold harmless and defend the Released Parties from any and all claims resulting from injuries or illness (including death), damages, or loss, including, but not limited to attorneys’ fees, sustained by me arising out of, connected with, or in any ways associated with the Fitness Room. 

5. In the event of any emergency, I authorize the Released Parties to secure from any licensed hospital, physician and/or medical personnel any treatment deemed necessary from my immediate care and agree that I will be responsible for payment of any and all medical services rendered (e.g. ambulance fees). 

6. I have been advised by The Sarah Carr Psychological Services to consult with a physician before I undertake any physical exercise program. I certify that I am in good health and sufficient physical condition to use the Fitness Room properly. I certify that I am knowledgeable about the proper use of any equipment that I will use and the rules of any activities that I will participate in and that I will carefully read the operating instructions for any Fitness Room equipment prior to use and will operate such equipment in strict accordance with instructions. 

7. I understand and agree to adhere to the Sarah Carr Psychological Services Fitness Room policies and rules, which are available for review at the main office front desk. I acknowledge that I have been provided a copy of these policies and rules. 

I have read and fully understand this Acknowledgement and Release of Liability set forth above, including the permission to secure medical treatment and the release of all claims, including claims for the negligence of the Released parties. I am 18 years old or older. I understand that my signed waiver will be retained in my employee personnel file/client file. This document is binding upon me and my heirs, children, wards, personal representatives and anyone else entitled to act on my behalf.