Waiver

Waiver  Release / Informed Consent

Please Print, Fill Out and Bring With You To The Studio

Release executed on the _____ day of ____________, 2009

by (name) ________________________________________(the ‘Releasor’)

of (address) ______________________________________________________________Arkansas,

Zip ____________

to Susanna Patterson of Y.E.S Your Exercise Specialist (the ‘Releasee’) of 301 Commerce Dr. Maumelle, Ar 72113.

I, the Releasor, being of lawful age, in consideration of being permitted to participate in an exercise class, scheduled for the_________day of______________,2009 and ending on the date I discontinue the class., and run and/or operated by the Releasee, WAIVE, RELEASE, and DISCHARGE the Releasee, her heirs, executors, administrators, legal representatives and assigns from all liability for or by reason of any damage, loss or injury to person and property, even injury resulting in the death of the Releasor, which has been or may be sustained in consequence of the Releasor’s participation in the activity described above, and notwithstanding that such damage, loss or injury may have been caused solely or partly by the negligence of the Releasee. I fully understand that I may injure myself as a result of my participation in the exercise program including but not limited to miscarriage, heart attack, muscle strains, or tears, broken bones, shin splints, knee-lower back/foot injuries and any other illness, soreness, or injury however caused occurring during or after my participation in the exercise program. I have been thoroughly informed of these risks and I assume all risks involved. I also acknowledge that I am in good physical and medical condition and that there is no physical or medical reason for me not to participate in the program.

I hereby acknowledge and agree that I have carefully read this Waiver Release / Informed Consent agreement, that I fully understand same, and that I am freely and voluntarily executing same.

By signing this release I will be forever prevented from suing or otherwise claiming against the Releasee for any property loss or personal injury that I may sustain while participating in or preparing for the above noted activity.____________(please initial)

I have been given the opportunity and have been encouraged to seek independent legal advice prior to signing this Waiver and Release agreement.

I understand that I would not be permitted to participate in the above noted activity unless I signed this Waiver and Release agreement.

I understand that this Waiver and Release agreement is binding on me, my spouse, my heirs, my executors, administrators, personal representatives and assigns.

I acknowledge that I do not have any physical limitations, medical ailments, physical or mental disabilities that would limit or prevent me from participating in the above mentioned activity, and, if required, will obtain a medical examination and clearance.

This release contains the entire agreement between the parties to this release and the terms of this release are contractual and not a mere recital.

This Waiver Release / Informed Consent Agreement will be construed in accordance with and governed by the laws of the State of Arkansas, and it is acknowledged by the Releasor to be as broad and inclusive as permitted by the laws of this jurisdiction.
_____  I am not pregnant.
_____  I am pregnant. (For your safety, if you are pregnant you are not eligible to participate in this class.)

I HAVE READ AND UNDERSTAND THIS AGREEMENT, AND I AM AWARE THAT BY SIGNING THIS AGREEMENT I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS AND ASSIGNS MAY HAVE AGAINST THE RELEASEE(S).

The Releasor has executed this Waiver and Release on the _____ day of ____________, 2009.

Signature of Releasor  ____________________________________________________________