This waiver form must be signed by all persons using the fitness facilities at Impact Fitness Center. Anyone under 14 must be supervised by a trainer. Users exercise at their own risk. The waiver releases Impact Fitness Center from liability for any injuries that may occur from using the facilities or equipment. It also allows the use of a person's name and image for promotional purposes. Signing confirms understanding and agreement to the waiver.

1. FITNESS/EXERCISE FACILITY WAIVER & RELEASE
This form must be completed by all persons who use Impact Fitness Center Exercise Facilities.
No one under the age of fourteen (14) may use the fitness/exercise facility or equipment at any time unless otherwise
approved, and directly supervised by an Impact Fitness Trainer. Use of fitness/exercise facilities and equipment are at the
user’s sole risk and responsibility.
I am aware that exercise can be physically stressful and in certain instances can even be harmful and result in death. I am
also aware that anyone who smokes; has ever had elevated blood pressure; is over 45 (men) or 55 (women) years of age;
presently does not exercise; has ever had cardiac (heart) problems; is overweight; has diabetes; has a family history of
cardiovascular problems; is susceptible to or has ever had orthopedic problems; or is pregnant, is more at risk while
exercising. I understand that I should consult with my personal physician before I begin or continue any exercise p rogram. I
also understand it is recommended that I have a physician’s consent and/or have my physician identify any limitations on
my exercise that I may have if any of these conditions or others exist.
I hereby waive, release, and forever discharge the North Dam Mill LLC & Impact Fitness Center LLC, and its respective
officers, directors, employees, agents, and affiliated organizations from and against any and all claims, liabilities, and
causes of action, whether foreseeable or unforeseeable, which may at any time arise out of or relate in any manner, directly
or indirectly, to my use of said fitness/exercise facility and/or equipment or participation in any services or programs related
thereto. This waiver and release shall include, but not be limited to a release of all claims, liabilities, and causes of action
which may arise at any time in connection with any personal or other injury to myself or others, or death caused by or
related to my use of said fitness/exercise facilities and/or equipment or participation in any services or programs related
thereto.
In additional consideration of being permitted by Impact Fitness Center LLC to use its facilities, I hereby permit North Dam
Mill LLC & Impact Fitness Center LLC to use my name, image and likeness fo r promotional purposes limited to its fitness
training programs and facilities. North Dam Mill LLC & Impact Fitness Center LLC promotional mediums include but are not
limited to print, radio, video, television and the internet.
My signature hereby affirms that I have fully and completely read, understand, and agree to this waiver and release and all
contents thereof.
Print Name: __________________________________________________________________DOB: ________________
Signature: _________________ __________________________________________________Date: ________________
Phone: __________________________________ Email: __________________________________________________
Staff: _____________ Data Entry: _____________Date Entered: _____________Manager Review: ________________
Impact Fitness Center, LLC.  207-602-6242  info@impactfc1.com