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Client Name {name}

North Idaho Bungee Fitness

RELEASE OF LIABILITY AND ASSUMPTION OF RISK 

I, , (“I” or “me”) desire to participate in  bungee dance classes, training, and other related services (the "Activity" or “Activities”) provided by North Idaho Bungee Fitness an Idaho limited liability company (“North Idaho Bungee Fitness”). As lawful consideration for being permitted by North Idaho Bungee Fitness to participate in the Activity, I agree to all the terms and conditions set forth in this agreement (this "Agreement"). 

I am aware and understand that the Activities are dangerous, involve the risk of serious injury, and/or death,  and/or property damage and I agree to follow all instructions so that I may safely participate in the Activities. I acknowledge that any injuries that I sustain may be compounded by negligent emergency response or the rescue operations of North Idaho Bungee Fitness. I acknowledge that I am voluntarily participating in the activities with the knowledge of the danger involved and hereby agree to accept and assume any and all risks of injury, death, or property damage, whether caused by the negligence of North Idaho Bungee Fitness or otherwise. I hereby consent to and permit any emergency treatment in the event of injury or illness. I represent and warrant that I am in good physical health and do not suffer from any medical condition, to include pregnancy which would limit my participation in the Activities, the classes and training offered by North Idaho Bungee Fitness. I understand that it is my responsibility to consult with a physician prior to, and regarding my, participation in any of the Activities, the classes and training offered. I acknowledge and agree that if I am under the influence of alcohol or intoxicating substances I will not engage in the Activities. I hereby confirm that I am not pregnant nor have any other diagnosed medical condition that might put myself at risk. I hereby confirm that I have no emotional or health problems incompatible with the Activities. 

I hereby expressly waive and release any and all claims, now known or hereafter known, against North Idaho Bungee Fitness, and its officers, directors, employees, agents, affiliates, successors, and assigns (collectively, with North Idaho Bungee Fitness, the "Released Parties"), on account of injury, death, or property damage arising out of or attributable to my participation in the Activities, whether arising out of the negligence of the Released Parties or otherwise. I covenant not to make or bring any such claim against the Released Parties, and forever release and discharge the Released Parties from liability under such claims. I shall defend, indemnify, and hold harmless the Released Parties against any and all losses, damages, liabilities, deficiencies, claims, actions, judgments, settlements, interest, awards, penalties, fines, costs, or expenses of whatever kind, including attorney fees, fees and the costs of enforcing any right to indemnification under this Agreement, and the cost of pursuing any insurance providers arising out or resulting from any claim of a third party related to the Activities. 

I hereby irrevocably authorize and license the Released Parties the right to use, display, publicly perform,  exhibit, transmit, broadcast, reproduce, record, photograph, digitize, modify, alter, edit, adapt, create derivative  works, and exploit my North Idaho Bungee Fitness, image, likeness, appearance, and voice in all materials created by or on behalf of the  Release Parties that incorporate any of the foregoing (collectively "Materials") all of which are owned solely by  the Released Parties, on a perpetual basis throughout the world and in any medium or format whatsoever now  existing or hereafter created and for any purpose, including but not limited to, advertising, public relations,  licensing, publicity, packaging, and promotion of the Released Parties and their affiliates and their businesses,  products, and services, without further consent from or royalty, payment, or other compensation to me. I hereby  irrevocably release and discharge the Release Parties from any and all claims I might have, including those for  copyright or trademark infringement, infringement of moral rights, defamation, invasion of rights of privacy or  rights of publicity, false light, physical or emotional injury or distress, or any similar claim or cause of action in  tort, contract, or any other legal theory, now known or hereafter known in any jurisdiction throughout the world  arising directly or indirectly from the exercise by the Release Parties of their rights hereunder and the use and  exploitation of the Materials. 

This Agreement constitutes the sole and entire agreement of North Idaho Bungee Fitness and me with respect to the subject matter contained herein and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral, with respect to such subject matter. If any term or provision of this Agreement is invalid, illegal, or unenforceable in any jurisdiction, such invalidity, illegality, or unenforceability shall not affect any other term or provision of this Agreement or invalidate or render unenforceable such term or provision in any other jurisdiction. This Agreement is binding on and shall ensure to the benefit of North Idaho Bungee Fitness and me and their respective successors and assigns. All matters arising out of or relating to this Agreement shall be governed by and construed in accordance with the internal laws of the State of Idaho without giving effect to any choice or conflict of law provision or rule (whether of the State of Idaho or any other jurisdiction). Any claim or cause of action arising under this Agreement may be brought only in the federal and state courts located in Kootenai County, Idaho and I hereby consent to the exclusive jurisdiction of such courts. 

BY SIGNING, I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD ALL OF THE TERMS OF THIS AGREEMENT, THAT I AM AT LEAST 16 YEARS OF AGE, AND THAT I AM VOLUNTARILY GIVING UP SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE North Idaho Bungee Fitness. 

Name (printed): {name} Birth Date: {dob}

Phone Number: {phone}  Address: {address} 

If the individual above is under 18 years of age, please complete the following: 

I am the parent or legal guardian of the individual North Idaho Bungee Fitness above, and I hereby sign this Release of Liability and Assumption of Risk on behalf of such individual in accordance with the statements above. I understand and agree to its provisions, consent to the emergency medical treatment and will be responsible for any and all costs. I have discussed with the participant the requirements to follow all instructions, observe rules and to act in a safe and prudent manner. I concur with representations made by the participant about physical capabilities and working order of equipment, and agree North Idaho Bungee Fitness may use his/her North Idaho Bungee Fitness, image, likeness, appearance, and voice.  

Parent Name or Guardian Name (printed):

Birth Date:

Date:

Phone Number: Address:

Health History Form

Name: {name} Date of Birth: {dob} 

Emergency Contact Name and Phone: {contact_name} {contact_phone}

RESTRICTIONS to participate: Weight must be between 90-250lbs. No recent surgeries (must be cleared by physician.) Can not be pregnant.  

Major surgeries and dates:

Past injuries:

Have you ever lost consciousness?  

If yes, please explain:

Describe any other health conditions that you have:

Current Medications:

Current exercise routine? 5-7 a week 2-4 a week 1-2 a week 1x or less a month  

What are your fitness goals:

How can we pray for you today?