Waiver

Name: ________________________________ Email: ___________________________ Phone:___________________________ 

Birthday: _________________________

 Assumption of Risk 

By signing up for and/or attending purvelo classes, activities and other programs, and using purvelo’s  premises, facilities, and equipment (collectively, Classes and Facilities), you hereby agree that there  are certain inherent risks and dangers in indoor cycling and exercise and in using indoor cycling and  exercise equipment in association with the Classes and Facilities. These inherent risks and their  consequences include but are not limited to minor injury, major injury or paralysis and death. 

______ I hereby affirm that I: 

(Client Initials) (1) am aware of the risks associated with the Classes and Facilities; (2) understand and appreciate the risks and their consequences; and 

(3) assume responsibility for the risks and their consequences. 

Waiver of Negligence 

In consideration of being allowed to participate in and access the Classes and Facilities provided by  purvelo, in addition to the payment of any fee or charge 

______ I affirm that I: 

(Client Initials) (1) assume full responsibility for any and all injuries or damage which are sustained  or aggravated by you in relation to the Classes and Facilities; 

(2) waive, release and forever discharge purvelo, its management, officers, agents, members,  employees, representatives, volunteers, sponsors, insurance carriers, equipment suppliers and all  others from any and all responsibility, claims, rights, causes of action and/or liability from injuries or  damages to my person or property resulting from my participation in and use of the Classes and  Facilities, including but not limited to ordinary negligence of the provider; and (3) make this waiver on behalf of myself, my spouse, heirs, administrators and assigns. 

Medical Conditions 

purvelo hereby advises you that individuals with any chronic disabilities or conditions are at risk in  using purvelo’s Classes and Facilities, and are advised against doing so. In addition, if in the opinion  of purvelo’s staff, you would be at physical risk using purvelo’s Classes and Facilities, you will be  denied access to purvelo and its Classes and Facilities until you furnish purvelo with an opinion letter  from your medical doctor, at your sole cost and expense, specifically addressing purvelo’s concerns,  and stating that purvelo’s concerns are unfounded. If you decline to obtain such a letter, you will not  be permitted to use the Classes and Facilities of purvelo. 

______ I affirm that I: 

(Client Initials) (1) have no health problems that preclude participation in the Classes and Facilities; (2) have not been instructed by a physician not to participate in the Classes and Facilities or similar  activities; 

(3) authorize emergency medical care if needed, including but not limited to first aid, CPR and AEDs,  emergency transport and sharing of medical information with medical personnel; (4) assume all costs involved in the provision of any emergency medical care provided pursuant to  (2) above; and 

(5) agree to follow all safety rules and instructions of management and staff and inform management  or staff of conduct or condition that might endanger myself or others.

Indemnification 

By signing below, you agree to indemnify, reimburse and hold harmless purvelo, its management,  officers, agents, members, employees, representatives, volunteers, sponsors, insurance carriers,  equipment suppliers and all others against all claims and costs associated with claims (including, but  not limited to legal costs, attorney fees, court costs and investigative costs), both (1) made by  yourself and your spouse, heirs, administrators and assigns arising out of an injury to the you, and  (2) made by co-participants, rescuers and others arising from your conduct during participation in  the Classes and Facilities. 

Duration and Integration 

The agreement supersedes any and all prior oral or written promises or agreements and shall remain  in full force and effect during this an all subsequent participation in the Classes and Facilities. Severability 

In case any provision in this agreement shall be invalid, illegal or unenforceable, the validity, legality  and enforceability of the remaining provisions shall, to the fullest extent permitted by applicable law,  not be in any way affected or impaired thereby and shall remain in full force and effect. Governing Law 

THIS AGREEMENT AND ANY DISPUTE ARISING OUT OF PARTICIPATION IN THE CLASSES AND  FACILITIES SHALL BE GOVERNED BY THE LAWS OF THE STATE OF VIRGINIA. Waiver of Jury Trial 

THE UNDERSIGNED HEREBY IRREVOCABLY WAIVES, TO THE FULLEST EXTENT PERMITTED BY  APPLICABLE LAW, ANY AND ALL RIGHT TO TRIAL BY JURY IN ANY LEGAL PROCEEDING ARISING OUT  OF OR RELATING TO THIS AGREEMENT OR PARTICIPATION IN THE CLASSES AND FACILITIES. 

I have read and understood this agreement. I understand that I am relinquishing substantial legal  rights, including the right of financial recovery for injury, whether the injury results from the inherent  risks of the Classes and Facilities or from the ordinary negligence of purvelo. I am voluntarily  participating in the Classes and Facilities and voluntarily signing this agreement releasing purvelo  from liability for injury or loss. 

Signature: _____________________________ Date: ____________________