Health & Fitness Liability Waiver / Informed Consent Form
I have enrolled in the health and fitness program offered by Pittsburgh FIT, owned by Jodi Butler, in Pittsburgh PA. I recognize that the program may involve strenuous physical activity including, but not limited to, muscle strength and endurance training, cardiovascular conditioning and training, and other various fitness activities.
I herby affirm that I am in good physical condition and do not suffer from any known disability or condition which would prevent or limit my participation in this exercise program. I acknowledge that my enrollment and subsequent participation is purely voluntary.
“I fully understand that I may injure myself as a result of my participation in the exercise
Program, and I hereby release Pittsburgh FIT, its agents/trainers/coaches, and Jodi Butler from any liability now or in the future for conditions that I may obtain. These conditions may include, but are not limited to, heart attacks, muscle strains, muscle tears, muscle pulls, broken bones, shin splints, heat prostration, injuries to knees, back, feet, or any other illness or soreness that I may incur, including death. “
By signing this form, I herby grant to pittsburgh FIT permission to reproduce my name, likeness, identity, voice, photographic image, video graphic image and oral or recorded statements in any publication of pittsburgh FIT intended for promotional, fundraising or other related use, including but not limited to social media, printed publications, web pages, and web based publication associated with pittsburgh FIT.
Monthly membership cancelation policy: I understand that I must notify pittsburgh FIT, in writing at least 7 business days prior to the monthly payment being charged to my card/account. A membership can be canceled by either completing a membership cancelation form, in the gym, or sending a certified letter to 210 Thomas St, Pittsburgh PA 15221.
Annual membership cancelation policy: I understand that I am entering into a 6-month or 12 month contract with pittsburgh FIT for unlimited monthly membership at a reduced monthly rate. I am responsible for the full cost of this agreement. I also understand that i can be relieved of this agreement by the following conditions:
1. Move more than 15 miles from a pittsburgh FIT facility
2. By death or disability that would prevent you from being able to utilize our gym.
I HEREBY AFFIRM THAT I HAVE READ AND FULLY UNDERSTAND THE