AGREEMENT/RELEASE AND WAIVER OF LIABILITY
Name: _________________________________
Address: (Street)__________________________
(City) ________________
(State) _______
Phone: ____________________________
(Zip)_____________
E-Mail: _____________________
I acknowledge and agree that this CHAIN REACTION FITNESS LLC Punch Card/ Contract/
Membership/ or Service is not transferable or assignable. I acknowledge that payment as specified above is
required to be paid in full regardless of whether or not I complete the Punch Card/ Contract/ Membership/ or
Service. I understand that I am purchasing the services Chain Reaction Fitness LLC offers and further
understand such services are not refundable for any reason. Prior to participating in CHAIN REACTION
FITNESS LLC. I understand that I should consult with my physician.
RELEASE & WAIVER OF LIABILITY. In enrolling at CHAIN REACTION FITNESS LLC, participant
understands that he/she is attending the programs and using CHAIN REACTION FITNESS LLC and the
facility at his/her own risk. CHAIN REACTION FITNESS LLC, and its Owners, employees or agents, shall not
be liable for any damage whatsoever arising from any personal injury, luding death, or property loss sustained
by participant or participant's family members in or about any programs rather on or off the premises.
Participants and parents assume full responsibility for all injuries and damages which occur in or about any
programs on or off the premises. He/She does hereby fully and forever release discharge hold harmless CHAIN
REACTION FITNESS LLC, all associated facilities and its Owners, employees, and agents from any and all
claims, demands, damages or rights of action, present or future resulting from the participation in any programs
or use of the facilities. In addition, he/she agree(s) to follow the rules of conduct and safety set by CHAIN
REACTION FITNESS LLC, and its Owners, employees or agents. Failure to do so may result in suspension
from participation.
Consent: I, the undersigned parent or guardian/participant, do hereby grant authority to the staff at
CHAIN REACTION FITNESS LLC, and its Owner, employees or agents to render a judgment concerning
medical assistance or hospital care in the event of an accident or illness during my absence. I do hereby
authorize CHAIN REACTION FITNESS LLC, and its Owner, employees or agents and its assigns to utilize
any and all photographs, pictures, videos or other likeness of me or anyone assigned guardianship to me, as they
deem appropriate in its promotional materials or films. I specifically waive any right to compensation for the
use of such photographs, pictures, videos, or other likeness.
I have read the above release and waiver of liability and understand its contents. I voluntarily agree to
the terms and conditions stated above. I agree that I am legally bound by its content.
Signature: __________________________
Date: ________________
Please make checks payable to Chain Reaction Fitness LLC.
Benji Williford · Chain Reaction Fitness LLC · 715-379-4249 · [email protected]