Emergency Contact Information :
Please check if Applicable :
Do you have any of the following conditions that may limit your physical activity? (check all that apply) :
What are your personal exercise program goals?
Are you currently involved in a physical exercise program?
By signing your name below as a participant in a class/Program sponsored by RESULTSONLY:
Studio Liability Release
By signing your name below as a participant in a class/Program sponsored by RESULTSONLY:(1) you acknowledge that participation in the Class/Program exposes you to possible risk of personal injury. You, being fully aware that participation in the Class/Program exposes you to a possible risk of personal injury, hereby release ROBERT KELLY AND RESULTS ONLY, LLC and its officers, directors, employees, agents, licensees, subsidiaries, consultants, trainers, independent contractors and affiliates, from any and all liability from property damage, personal injuries or other claims arising from or in connection with your participation in the Class/Program including claims that are known and unknown, foreseen and unforeseen, future and contingent:(2) represent to ROBERT KELLY AND RESULTS ONLY, LLC that you are in excellent health and physical condition and have no disability or condition that would make it dangerous, harmful or inadvisable for you, or to do so that you have, to the extent you deem necessary, consulted and been so advised by a medical doctor:(3) ASSUME THE RISK OF AND RELEASE AND HOLD ROBERT KELLY AND RESULTSONLY,LLC HARMLESS FOR ANY LIABILITY FOR ANY PHYSICAL OR OTHER INJURY OR HARM SUFFERED BY YOU DURING OR AS A CONSEQUENCE OR PARTICIPATING IN THE CLASS/PROGRAM OR PERFORMING ANY SUCH EXERCISE ROUTINES OR ENGAGING IN SUCH OTHER STRENUOUS PHYSICAL ACTIVITY AND AGREE THAT NEITHER ROBERT KELLY AND RESULTS ONLY, LLC NOR ANY FACILITY AT WHICH THIS PROGRAM IS BEING HELD NOR ANY OTHER PERSON INVOLVED IN ORGANIZING OR CONDUCTING THIS PROGRAM SHALL HAVE ANY LIABILITY OR RESPONSIBILITY FOR ANY SUCH INJURY OR HARM.You covenant that you shall not now or at any time in the future directly or indirectly, commence or prosecute any action, suit or other proceeding against ROBERT KELLY AND RESULTS ONLY, LLC and its officers, directors, employees, agents, licensees, subsidiaries, consultants, trainers, independent contractors and affiliates, rising out of or relating to the actions, causes of action, claims and demands hereby waived, released or discharged by you.For good and adequate consideration, which you acknowledge you have received, you hereby grant, release, and quit claim to ROBERT KELLY AND RESULTS ONLY, LLC to the right and authority to use, sell, reproduce, and distribute, quoted material, biographical information, my photograph, likeness, recorded voice, or videotaped filmed appearances (The Materials) for promotional or advertising purposes or programs as ROBERT KELLY AND RESULTSONLY, LLC in its sole discretion shall deem appropriate.You acknowledge that you have, are, and fully understand the Injury Waiver and General Release Form. This agreement shall be binding on you, your spouse, your children, legal representatives, heirs, successors and assigns.
Studio Liability Release Agreement