Name

First Name

Last Name

Email Address

Address

Cell Phone Number

How did you hear about us

Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?

Please Check Yes or No for the next 12 Questions

Yes

Do you feel pain in your chest when you perform physical activity?

Yes

In the past month have you had chest pain when you were not performing physical activity?

Yes

Do you lose your balance because of dizziness or do you ever lose consciousness?

Yes

Do you have a bone or joint problem that could be made worse by a change in your physical activity?

Yes

Is your doctor currently prescribing any medication for your blood pressure or for a heart condition?

Yes

Do you know of any other reason why you should not engage in physical activity?

Yes

Have you ever had any joint injuries?

Yes

Have you ever had surgeries?

Yes

Has a medical doctor ever diagnosed you with a chronic disease?

Yes

Are you currently taking any medication?

Yes

Do you have a hernia, or had a hernia in the past?

Yes

Please Detail Any Question You Answered "Yes" to above.

If you have answered yes to one or more of the above questions, consult your physician before engaging in physical activity. Tell your physician which questions you answered yes to. After a medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition.

Release Of Liability

For All Associates and Ambassadors Release Waiver of Liability, Assumption of Risk, Indemnity, and parental Consent Agreement.

For All Associates and Ambassadors Release Waiver of Liability, Assumption of Risk, Indemnity, and parental Consent Agreement. In consideration of being permitted to participate in physical exercise programs at MesserFit LLC, designed or administered by MesserFit LLC. I, my personal representatives, assigned heirs and next to kin: 1. I ACKNOWLEDGE, agree, and represent that I understand the nature of the activity and that I am qualified, in good health and in proper physical condition to participate in such activity. I further agree and warrant that if at any time I believe conditions to be unsafe; I will immediately discontinue further participation in the activity. 2. I FULLY UNDERSTAND that: (a) ATHLETIC ACTIVITIES INVOLVE RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDING RHABDOMYOLYSIS, BROKEN BONES, TORN MUSCLES, RUPTURED or TORN TENDONS or LIGIMENTS, PERMANENT DISABILITY, PARALYSIS, AND DEATH: (b) these Risks and dangers may be caused by my own actions or the actions of others participating in the activity, the condition in which the activity takes place, or THE NEGLIGENCE OF THE RELEASEES NAMED BELOW: there may be OTHER RISKS AND SOCIAL AND ECONOMIC LOSSES either not known to me or not readily foreseeable at this time: and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of my participation or that of the minor in the activity. 3. I HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE MESSERFIT LCC, Mark Andrew Messer, or anyone associated with MesserFit LLC or Mark Andrew Messer, as well as the officers, directors, agents, employees and assigns of each, and MesserFit LLC, clubs, coaches, officials, administrators, members, volunteers, participants, sponsors, advertisers, and if applicable, owners and lessors of premises on which the activity takes place, and any other party indemnified and held harmless by MesserFit LLC or Mark Andrew Messer, (each considered one of the RELEASEES herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSES, OR DAMAGES ON MY ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, NEGLIGENT SECURITY, AND RECREATIONAL OPERATIONS AND ACTIVITIES; AND I FURTHER AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT I, or anyone on my behalf, makes a claim against any of the Releases, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation expense, attorney fees, loss, liability, damage, or cost which any may incur as the result of such claim. 4. I am to be solely held responsible for any damages I may cause willingly or by accident to the property of MESSERFIT LLC or Mark Andrew Messer. I will pay in full personally, for any damages that may occur on my behalf, directly to the MESSERFIT LLC. I agree that MESSERFIT LLC is not responsible for my actions, only I and I alone am responsible for any debts that may occur. I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID, THE BALANCE, NOT WITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.

Understanding Of Payment Cycles

At MSC we do not do per session billing. We run on monthly billing cycles across all spectrum's of service products. (Example: Unlimited S&C at 195$ per month.) You must satisfy the service due on a monthly basis and must give 30 days notice if you with to cancel the service. So, if it's June 25th and you want to cancel for your billing for July 15th, It's to late, you will be billed for July and your draw will terminate after that.) *Any termination fees will also be assessed at that time if they apply.

MINORS RELEASE

MINORS RELEASE AND I, THE MINORS PARENT AND/OR LEGAL GUARDIAN, UNDERSTAND THE NATURE OF ATHLETIC ACTIVITIES AND THE MINORS EXPERIENCE AND CAPABILITIES AND BELIEVE THE MINOR TO BE QUALIFIED, IN GOOD HEALTH, AND IN PROPER PHYSICAL CONDITION TO PARTICIPATE IN SUCH ACTIVITY. I HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE, AND AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS EACH OF THE RELEASES FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON THE MINORS ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE RELEASES OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS AND FURTHER AGREE THAT IF, DESPITE THIS RELEASE. I THE MINOR OR ANYONE ON THE MINORS BEHALF MAKES A CLAIM AGAINST ANY OF THE RELEASEES NAME ABOVE, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES FROM ANY LITIGATION EXPENSES, ATTORNEY FEES, LOSS LIABILITY, DAMAGE, OR COST ANY MAY INCUR AS THE RESULT OF ANY SUCH CLAIM.

I Have Read and Understand The Release of Liability

Yes

Date

YYYY

Name of Minor is signing for Minor

First Name

Last Name

Name of Minor If signing for Minor

First Name

Last Name

Signature

This is my Electronic Signature and I have not made any false claims.

First Name

Last Name

Health History and Liability Release