Liability Release - Virtus Barbell

Paticipant Information

Name*

First Middle Last

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Phone*

Date of Birth*

Emergency Contact

Name*

First Last

Phone*

Policies

Fee Policy*

Not Applicable
PT - Trainee agrees to pay Trainer per session in full prior to each training session. Trainee will pay $35 for any check that is returned due to insufficient funds.
Open Gym Drop-In Day $15
GroupFit Drop-In $15
Open Gym Drop-In Week $40
Open Gym Drop-In Month $70
PowerAlpha
PowerSproutz / PowerTotz / PowerKidz
Competition / Event

Assumption of Risk of Injury and Waiver of Claims*

I agree.

Trainee assumes all risks of injury and waives all rights to pursue money damages or any other relief of any kind as a result of anything occurring at or near the training facility. In the event Trainee is injured during or as a result of a training session, Trainee will hold harmless the Trainer, Virtus Barbell, its successors, assigns, owners, officers, directors, employees, and agents from all claims of any sort for damages or for other relief, including but not limited to claims for contribution. Trainee acknowledges there is possible danger connected with any physical activity (including the dangers of physical injury and death) and knowingly and voluntarily waives Trainee's right to make a legal or equitable claim or any sort against the Trainer, Virtus Barbell, its successors, assigns, owners, officers, directors, employees, and agents from all claims of any sort for damages or for other relief, including but not limited to claims for contribution. This assumption of risk and waiver of liability applies to Trainee's family members, successors, heirs and assigns.

Damaged, Lost or Stolen Property*

I agree.

Trainee understands that Virtus Barbell and its owners are not responsible for any of Trainee's personal property that is damaged, lost or stolen while in or around the training facility. Trainee understands and agrees that Trainee is liable for all damage Trainee causes to the equipment or physical infrastructure of the training facility and will reimburse the Virtus Barbell for any damage Trainee causes.

Physical Condition and No Medical Advice*

I agree.

Trainee represents that Trainee is in good physical condition and has no medical reason or impairment that might prevent Trainee from participating in personal training. If Trainee has any health or medical concerns now or in the future, Trainee will discuss them with Trainee's doctor before using the facilities.

Rules and Regulations*

I agree.

Trainee agrees to follow Virtus Barbell's rules posted at the facility or communicated by owners or Trainer. Virtus Barbell may, in its sole discretion, modify its rules or policies without notice at any time.

Rules and Regulations*

I agree.

1. Theft will not be tolerated. Do not touch other member’s belongings. Equipment must stay on Virtus property. Anyone caught stealing will be banished from the facility.
2. Everyone is required to help maintain a safe and clean environment. This means placing personal belongings in the designated area, putting equipment away after use, throwing trash in garbage cans, and wiping down equipment and touch surfaces with provided cleaning products before and after use.
3. Profanity is only permitted following immense physical exertion or for motivational purposes, not for normal conversation. It is unbecoming of a Virtus member.
4. Only partners of Virtus Barbell and independent contractors that have signed the appropriate paperwork can train clients in the facility.
5. No one under the age of 18 is permitted to train at Virtus Barbell without a Virtus trainer or being involved in a Virtus Program.
6. Be smart. When lifting heavy, ask for a spot. Do not set yourself up for failure at 3:00am with nobody to help you.
7. If training alone after staffed hours the provided emergency alert lanyard must be worn.
8. Do not interrupt others actively training. Do not ask questions to trainers who are in the middle of coaching sessions. Be sure to give other members appropriate space. Keep the floor clear for those doing gait drills, walks, and sled work.
9. There will be no unsolicited comments about other training styles. Do not give advice regarding things you have never tried or have no experience with. If someone asks for advice, feel free to give it.
10. Do not enter “other” areas not designated as exercise space (i.e.: utility rooms, treatment room, offices) without a Virtus partner/owner.
11. Do not enter Virtus Barbell with a negative attitude or conduct yourself in a negative way. You will be required to leave. Always support your training partners/other members.
12. Members and Guests agree to follow all Pennsylvania public health advisories in regards to COVID-19 mitigation or any other health event.

Promotional Material Release*

I agree.

Trainee understands that Trainer and/or Virtus Barbell may produce promotional materials and that Trainee's name, likeness, image, voice, appearance and/or training sessions may be photographed and video recorded and made a part of such promotional materials. Trainee hereby grants Trainer and Virtus Barbell the irrevocable right to use Trainee's name (or any fictitious name), likeness, image, voice, appearance, and training sessions as embodied in the promotional materials whether recorded on or transferred to videotape, film, slides, photographs, audio tapes, DVDs or other media now known or later developed. This grant includes without limitation the right to edit, digitally enhance or alter, mix or duplicate and to use or re-use the promotional materials in whole or part, as Virtus Barbell may elect. Trainee hereby waives any right to inspect or approve the finished product, including written copy or any other products that may be created in connection therewith. Trainer and Virtus Barbell shall have complete ownership of the promotional materials in which Trainee appears, including copyright interests. Trainee grants Trainer or Vitus Barbell the right to broadcast, exhibit, market, sell and distribute the promotional materials, either in whole or in parts, for any purposes that Trainer or Virtus Barbell, in their sole discretion, may determine, including without limitation advertising and promotion. Trainee confirms that Trainee has the right to enter into this Agreement and herby gives all clearances, copyright and otherwise, for use of Trainee's name, likeness, image, voice, appearance, and training sessions embodied in the promotional materials. Trainee expressly releases and indemnifies Trainer or Virtus Barbell, its successors, assigns, owners, officers, directors, employees, agents and licensees from any and all claims including, without limitation, any and all claims for invasion of privacy, infringement of my right of publicity, defamation (including libel and slander) and any other personal and/or other property rights, arising out of or in any way connected with the above granted uses and representations. Trainee agrees that Trainee shall not now or in the future assert or maintain any such claim against Trainer or Virtus Barbell, its successors, assigns, owners, officers, directors, employees, agents and licensees.

Parental/Guardian Consent

I agree.

The undersigned persons are the parents or guardians of the Trainee in this Agreement and make this agreement for the purpose of enabling the Trainee to participate in personal training use the facilities of Virtus Barbell. The undersigned persons consent to the Trainee participating in personal training and using Virtus Barbell training facilities and are aware of the risks involved in such participation and use. The undersigned persons further agree that this consent shall constitute a bar to any recovery by them for any loss to them due to such participation and use, including but not limited to loss of the Trainee's services or companionship or loss of or damage to any personal property. The undersigned persons hereby hold the Trainer and Virtus Barbell, its successors, assigns, owners, officers, directors, employees, and agents harmless from all claims which may be brought against them by the undersigned persons, Trainee or on Trainee's behalf or by Trainee's family for any such injuries or claims aforesaid and the undersigned persons for themselves and on behalf of Trainee and Trainee's family, executors, administrators, and personal representatives do hereby forever release and discharge the Trainer and Virtus Barbell, its successors, assigns, owners, officers, directors, employees, and agents from all claims, demands, injuries, damages, actions, losses and expenses. The undersigned persons understands that Trainer and/or Virtus Barbell may produce promotional materials and that Trainee's name, likeness, image, voice, appearance and/or training sessions may be photographed and video recorded and made a part of such promotional materials. The undersigned persons hereby grant Trainer and Virtus Barbell the irrevocable right to use Trainee's name (or any fictitious name), likeness, image, voice, appearance, and training sessions as embodied in the promotional materials whether recorded on or transferred to videotape, ﬁlm, slides, photographs, audio tapes, DVDs or other media now known or later developed. This grant includes without limitation the right to edit, digitally enhance or alter, mix or duplicate and to use or re-use the promotional materials in whole or part, as Trainer or Virtus Barbell may elect. The undersigned persons hereby waive any right to inspect or approve the finished product, including written copy or any other products that may be created in connection therewith. Trainer and Virtus Barbell shall have complete ownership of the promotional materials in which Trainee appears, including copyright interests. The undersigned persons grant Trainer or Virtus Barbell the right to broadcast, exhibit, market, sell and distribute the promotional materials, either in whole or in parts, for any purposes that Trainer or Virtus Barbell, in their sole discretion, may determine, including without limitation advertising and promotion. The undersigned persons conﬁrm that he/she/ they have the right to enter into this Agreement and hereby gives all clearances, copyright and otherwise, for use of Trainee's name, likeness, image, voice, appearance, and training sessions embodied in the promotional materials. The undersigned persons expressly release and indemnify Trainer or Virtus Barbell, its successors, assigns, owners, officers, directors, employees, agents and licensees from any and all claims including, without limitation, any and all claims for invasion of privacy, infringement of my right of publicity, defamation (including libel and slander) and any other personal and/or other property rights, arising out of or in any way connected with the above granted uses and representations. The undersigned persons agree that Trainee shall not now or in the future assert or maintain any such claim against Trainer or Virtus Barbell, its successors, assigns, owners, officers, directors, employees, agents and licensees.

Additional Notes

If Signing For a Minor Please Type Name Below

First Middle Last Relation (Parent or Guardian)

Signature*

Name

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