Waiver

READ CAREFULLY - THIS AFFECTS YOUR LEGAL RIGHTS


I hereby assign and grant to Melinda Perez, Ignyte GBM, its subsidiaries and successors, the unqualified right to ownership, use and proceeds of all photographs and video recordings of me, without reservation or limitation, including use of photographs and video of me for advertising and promotional purposes.


In consideration of being allowed to participate in any way in the Ignyte GBM program, related events and activities, the undersigned acknowledges, appreciates, and agrees that:

  1. I understand Ignyte GBM includes physical movements as well as an opportunity for relaxation, stress re-education and relief of muscular tension. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. If I experience any pain or discomfort, I will listen to my body, discontinue the activity, and ask for support from the instructor. I will continue to breathe smoothly.  

  2. Ignyte GBM is not a substitute for medical attention, examination, diagnosis or treatment. Ignyte GBM is not recommended and is not safe under certain medical conditions. By signing, I affirm that a licensed physician has verified my good health and physical condition to participate in such a fitness program. In addition, I will make the instructor aware of any medical conditions or physical limitations before class. If I am pregnant, become pregnant or I am post-natal or post-surgical, my signature verifies that I have my physician's approval to participate.

  3. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releasees or others, and assume full responsibility for my participation; and,

  4. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,

  5. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release and hold harmless Melinda Perez and Ignyte GBM, their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“Releasees”), with respect to any and all injury, disability, death or loss or damage to person or property, whether arising from the negligence of the releasees or otherwise, to the fullest extent permitted by law.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.


FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF REGISTRATION)

This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above, even if arising from their negligence, to the fullest extent permitted by law.


*
Name *
Name
I certify that I am at least 18 years old. *
Today's Date *
Today's Date
Parent/Legal Guardian
Parent/Legal Guardian
Phone
Phone
Emergency Contact *
Emergency Contact
Phone *
Phone