Liability Waiver

I, _______________________________, have enrolled in a program offered by Dori Young, 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 hereby 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 and is in no way mandated. In consideration of my participation in this program, I hereby release Dori Young from any claims, demands, and causes of action as a result of my voluntary participation and enrollment. I fully understand that I may injure myself as a result of my enrollment and subsequent participation in this program and I hereby release Dori Young from any liability now or in the future for conditions that I may obtain. I hereby release Dori Young from any claims that may arise in the future as the result of injury or loss I suffer as the result of negligence by Dori Young in the provision of services to me. These conditions may include, but are not limited to, heart attacks, strokes, muscle strains, muscle pulls, muscle tears, broken bones, shin splints, injuries to knees or other joints of the body, injuries to back or neck, injuries to a foot, heat prostration, or any other illness or soreness that I may incur, including death.

Photo release:

Dori Young periodically takes photographs and/or video for advertising purposes including but not limited to print ads and website. I hereby grant Dori Young permission to use my likeness in a photograph in any and all of its publications, including website entries, without payment or any other consideration. I understand and agree that these materials will become the property of Dori Young and will not be returned. I hereby irrevocably authorize Dori Young to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing Dori Young programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph. I hereby hold harmless and release and forever discharge Dori Young from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. I am 21 years of age and am competent to contract in my own name. I have read this release before signing below and I fully understand the contents, meaning, and impact of this release.

I HEREBY AFFIRM THAT I HAVE READ AND FULLY UNDERSTAND THE ABOVE STATEMENTS, THEIR MEANING, AND THE IMPACT OF THIS RELEASE.

 

BY SIGNING BELOW I HEREBY AFFIRM THAT I HAVE READ AND FULLY UNDERSTAND THE STATEMENTS ON THE WELLNESS WITH DORI "Liability Waiver /Informed Consent Form" (at www.wellnesswithdori.com/fitness/liability waiver), THEIR MEANING, AND THE IMPACT OF THIS RELEASE.

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