VASA Fitness

Liability Waiver


Member Name Last First Date of Birth
   
Member Address Street City ST Zip
 
Member Phone     By signing this document, you agree that VASA Fitness, along with its agents and affiliates, may call you for marketing purposes at the telephone numbers you provide to VASA, which you certify are your own numbers, including the possible use of automated technology, prerecorded messages and texts. You are not required to consent in order to make a purchase and you may opt out at any time.
   
Member Email        
       
Emergency Contacts Name Phone    
 

WAIVER OF LIABILITY: ASSUMPTION OF RISK AND RISK OF ACCIDENT

  • Member represents that the member(s) (buyer and member may be the same person) is/are covered under their own insurance policies, covering any personal injuries to them personally or which they may cause to others, or which may be caused to them by others. The member agrees to deal directly with member's own carrier, and not VASA Fitness, on any claim. Member acknowledges that their membership cost reflects savings due to the fact that the Member provides their own insurance.
  • ANY PERSON USING THE EQUIPMENT OR THE FACILITIES DOES SO AT THEIR OWN RISK.
  • It is further agreed that all exercises, including the use of weights, number of repetitions, and use of any and all machinery, equipment, facilities, amenities and apparatus shall be at the Member's sole risk. Notwithstanding any consultation on exercise programs which may be provided by gym employees, it is hereby understood that the selection of exercise programs, methods and types of equipment shall be the Member's entire responsibility.
  • VASA FITNESS SHALL NOT BE LIABLE TO MEMBER FOR ANY CLAIMS, DEMANDS, INJURIES, DAMAGES, OR CAUSES OF ACTION ARISING DUE TO INJURY TO MEMBER, THEIR PERSON, OR PROPERTY ARISING OUT OF OR IN CONNECTION WITH THE LOCATED, WHETHER CAUSED BY NEGLIGENCE OR OTHERWISE. SE BY MEMBER OF THE SERVICES AND FACILITIES O THE PREMISES HERE THE SAME IS LOCATED, WHETHER CAUSED BY NEGLIGENCE OR OTHERWISE.
  • Member hereby holds VASA Fitness, its employees and agents harmless from all claims which may be brought against them by Member or on either of their behalf for such injuries or claims aforesaid. Member shall also examine each piece of equipment prior to use and refrain from use and report the same if there is any indication that the equipment has been subjected to abuse, is damaged, or is in an unsafe or potentially dangerous condition. Member has a duty to exercise care for the protection of himself and other members while using the premises.
  • If any accident is caused by a defect or faulty design of the equipment, the injured party will direct any claim against the manufacturer, holding VASA Fitness harmless and subrogate their rights, if any, to VASA Fitness.
  • Member, if injured, or Member's representative if Member is unable to do so, must report any injury to VASA Fitness management immediately after any incident has occurred. Member must also complete, sign and deliver a written incident report to VASA Fitness management within twenty four (24) hours of the time of occurrence.
  • Member represent that they have read and agree to abide by the rules and regulations of VASA Fitness. Member agrees to report any violation of the rules and regulations by other gym users to gym management. Notwithstanding the fact that every gym user has agreed to abide by the rules and regulations, Member recognize that VASA Fitness employees cannot monitor every gym user for a violation of the rules. VASA Fitness shall not be liable to Member for any claims, demands, injuries, damages, or causes of action arising due to breach of gym rules by other gym members or users, or any conduct of gym members or users.
  • Failure of Member to comply with this agreement or any rule or regulation shall be cause for revocation of membership without notice and without any liability for refund.
  • Member agrees and hereby authorizes VASA Fitness to use any picture, image, video footage, statement, etc. captured within the facility for personal files, newsletters, and promotional purposes such as newspaper articles, videos, advertisements, flyers, etc.
  • MEMBER FULLY ASSUMES THE RISK THAT THEY MAY SUFFER PROPERTY DAMAGE, ILLNESS, SEVERE PERSONAL INJURY, OR EVEN DEATH BY USE OF GYM FACILITIES.

FEES, RULES AND REGULATIONS (SUBJECT TO CHANGE WITHOUT NOTICE)

  1. HOURS-The hours of operation shall be posted on the premises. Hours and days of operation shall be subject to change at the sole discretion of the Corporation.
  2. HOLIDAYS OR CLOSED DAYS/MAINTENANCE-The facilities may be temporarily closed for maintenance purposes, holidays, or for other temporary reasons at the sole discretion of management.
  3. MEMBERSHIP CARDS/SIGN-IN-All members upon entering are required to provide a VASA Fitness issued barcode or use the VASA Fitness app to enter the gym facilities. Replacement of lost cards will be made upon (a) providing proof of membership, (b) providing picture identification, and (c) paying a reasonable fee. Unauthorized use of cards or facilities will subject user and member to civil and/or criminal penalties and/or non-refundable cancellation of membership privileges.
  4. LOCKERS-Lockers are provided as a courtesy for day use only, and their availability is not guaranteed. Members shall provide their own locks. Combination locks are preferred. All personal belongings must be placed in lockers and not left in dressing room booths. VASA FITNESS IS NOT RESPONSIBLE FOR LOST, STOLEN OR DAMAGED ARTICLES. DO NOT BRING VALUABLES TO THE PREMISES.
  5. GUEST PRIVILEGES-All guests must present a valid guest pass and state issued photo identification to access the facilities. All guests must be at least 18 years of age or under the guidance of a parent or legal guardian. A guest fee may be required. Guests who do not present a valid guest pass or guests who are from out of town will be assessed a ten dollar fee ($10)/visit for use of facilities.
  6. DAY CARE-Day Care is provided only while the member is on the gym premises. Reservations are required. Management policies and state regulations dictate Day Care hours and rules. Rates, hours and policies may be changed at any time, and without notice, at management’s discretion. Additional fees may apply.
  7. CLEANLINESS AND CLOTHING- Close-toed shoes and suitable, presentable and clean clothing in good repair is to be worn by member at member's own expense. Members wearing clothing deemed inappropriate by management may be asked to leave the facilities. All members MUST shower each time before entering the pool or Jacuzzi.
  8. COURTESY-To promote safety and more time efficient exercise programs, remember to return all plates, dumbbells and barbells to designated racks. YOU MUST RE-RACK YOUR WEIGHTS. Dropping weights, not re-racking weights, not cleaning equipment after use, and generally displaying poor care for the facilities will subject member and users to revocation of membership without refund. During high-traffic workout hours, be sure to encourage members to “work in” with you between sets during your rest period.
  9. FOUL LANGUAGE-Foul language will not be tolerated.
  10. OTHER POSTED RULES-Reasonable rules and regulations may be posted from time to time regarding the health, protection, or safety of members, and all Membership Agreements shall be subject to strict compliance therewith. Additional rules for the protection of members and the facilities may be added at any time.
  11. VIOLATION-Failure by member to comply with this agreement or any rule or regulation shall be cause for revo cation of membership without any notice and without any liability for refund of paid dues or future payment of dues as agreed to in this agreement.
  12. PAYMENT DEFAULT-Should member default on any installment or payment due hereunder, member and any additional members included in this agreement forfeit use of all facilities until all past due installments, payments, and fees are paid.
  13. TRANSFERRING–Membership may not be transferred to another fitness facility other than those under the management of VASA Fitness or its assignees. Assigning a membership to another person may occur when the member has found a buyer who wishes to fulfill the remaining terms of the agreement. All payments received by VASA Fitness will remain property of VASA Fitness. A transfer fee of one hundred dollars ($100.00) payable to VASA Fitness shall be paid. Only full priced memberships may be assigned. No family add-on, special price, complimentary, or trade memberships may be assigned.
  14. CHANGES-The only person authorized to change or inquire on this agreement is the adult member named as buyer of the agreement.
  15. CEASED OPERATION- IN THE EVENT THE HEALTH SPA FACILITY CLOSES AND ANOTHER HEALTH SP A FACILITY OPERATED BY THE SELLER OF THIS AGREEMENT, OR ASSIGNS OF THE SELLER, IS NOT AVAILABLE WITHIN FIVE (5) MILES OF THE LOCATION THE CONSUMER INTENDS TO PATRONIZE, SELLER WILL REFUND TO CONSUMER A PRORATA SHARE OF THE AGREEMENT COST, BASED UPON THE UNUSED TIME REMAINING ACCORDING TO THE AGREEMENT.
  16. AMENITIES-Amenities and services vary between clubs and membership type. VASA Fitness reserves the right to change or charge for specific amenities.
  17. MINOR-All members that sign the membership agreement, assumption of risk, and rules and regulations shall be assumed to be 18 years of age or older, or in the case of a minor member, that the buyer is the parent or legal guardian of the minor member. By signing any of these categories, member incorporates responsibility of proof of legal age and/or guardianship.
  18. E-MAIL ADDRESS-To facilitate notification to member of new membership benefits, holiday hours, fitness tips, etc., member agrees that by providing their e-mail address either on the front of this agreement or through other means that VASA Fitness and their partners may contact them via e-mail. This contact may be in the form of newsletters, offers, or any other method.
  19. STRIKING CLAUSE-If any portion of this agreement is found to be in violation of any laws, it shall be stricken from the agreement and shall have no effect on the viability of the remaining agreement terms including the reverse side of this agreement.
  20. COMPLETE AGREEMENT–members acknowledge that no oral promises or statements are part of this agreement.

Waiver and Assumption of Risk

Please consult with your physician before beginning any exercise program.

I acknowledge that I have voluntarily chosen to participate in one or more physical exercise orfitness activity or sport programs (the “Programs”). I acknowledge (i) the nature of the risks of the particular Programs in which I have chosen to participate, and (ii) the strenuous nature of those Programs. I understand, for example, the risks associated with physical injury, abnormal blood pressure, heart attack and even death; as well as the risks associated with the negligence of a Tivity Health Services, LLC participating location and any other organization or individual participating or involved in providing or promoting any classes, functions, Programs, testing, or other activities that I participate in as a Tivity HealthTM Program member (including without limitation the owners, officers, directors, employees, and representatives of any of the foregoing).

By signing this document, I expressly assume all risk for my health and well-being and expressly assume the other risks associated with participating in the Programs, including, but not limited to, the negligence of a Tivity Health participating location and any other organization or individual participating or involved in providing or promoting any classes, functions, Programs, testing, or other activities that I participate in as a Tivity Health Program member (including without limitation the owners, officers, directors, employees, and representatives of the foregoing). I also hereby release, waive, discharge and covenant not to sue any class instructor, any Tivity Health participating location, any sponsoring organization, Tivity Health, Inc., or any of their subsidiaries or any other organization or individual providing or promoting classes, functions, Programs, testing, or other activities that I participated in as a Tivity Health Program member (including without limitation the owners, officers, directors, employees, and representatives of any of the foregoing) at any time hereafter, from any and all demands, liabilities, losses, or damages (including death, bodily injury or damage to property) caused or alleged to be caused in whole or in part by the negligence of any of the foregoing people or entities. In addition, I agree that Tivity Health may engage in – and I hereby expressly consent to – (i) the recording (in video and/or still photo format) of my participation in Tivity Health classes, workshops or other programs, and (ii) the publication or other use by Tivity Health of any such recordings in social media, broadcast media, print media, general advertising and similar purposes.

I have read and understand this waiver and express assumption of risk. I have also read, understand, and will adhere to all guidelines and policies in regard to this benefit. This waiver and release shall survive the term of any agreement with a Tivity Health participating location or individual.

In the event that my physician has recommended any limitations to my physical activity or I have experienced any of the following conditions, I hereby attest that I have informed my physician of the condition(s) and have obtained express consent from my physician to participate in the Programs.

  • Chest pains while at rest and/or during exertion, previous heart attack or high blood pressure
  • Any heart or circulatory conditions, such as vascular disease, stroke, chest pain, congestive heart failure, poor circulation to the legs, valvular heart disease, blood clots
  • Frequent fast, irregular heartbeats OR very slow heartbeats
  • Diabetes
  • Previous hip or spinal fracture (as an adult)
  • Lung disease or shortness of breath after mild exertion, at rest, or in bed
  • Open cuts on my feet that do not seem to heal
  • An unexplained weight loss of ten (10) pounds or more in the past six (6) months
  • More than two falls in the past year (no matter what the reason)
  • More than one year since I have engaged in regular physical activity

 

   

Member's Name

   

 

Emergency Contact Name

 

Contact Phone Number

SSFP2981WAIVER0617

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Signature Certificate
Document name: Liability Waiver
lock iconUnique Document ID: 998a718df3681638d7ed2d1d946340cc50a5e2cf
Timestamp Audit
March 4, 2020 4:22 pm MSTLiability Waiver Uploaded by VASA Fitness - info@vasafitness.com IP 24.116.108.151