Liability Waiver

Personal Information:

Name: ______________________________________________ Date of Birth: ____/____/____

Address: ____________________________________________ Phone: ___________________
City/State/Zip: _________________________________________________________________
Emergency Contact Person: _______________________________________________________
Emergency phone: _________________ Relationship to emergency contact: ________________

WE RECOMMEND THAT YOU CONSULT YOUR PHYSICIAN BEFORE STARTING ANY

EXERCISE PROGRAM.

I hereby affirm that I am in good physical condition and do not suffer from any mental or physical
disability which would prevent or limit my participation in training with an independent contractor
(personal trainer) at Peak Performance, LLC, _____ (initial). I understand that I am participating
in a program of strenuous physical activity including, but not limited to, aerobic dance, weight
training, stationary bicycling and other conditioning classes and machines offered by Peak
Performance, LLC.

Using the services of Peak Performance Fitness, LLC and/or The Edge Gym involves the risk of injury to
you or your guest, whether you or someone else causes it. Specific risks vary from one activity to another
and the risks range from minor injuries to major injuries, such as catastrophic injuries including death. In
consideration of your voluntary participation in the activities offered by Peak Performance Fitness,
LLC, you understand and voluntarily accept this risk and agree that Peak Performance Fitness, LLC,
The Edge Gym, its officers, employees, volunteers and agents will not be liable for any injury,
including without limitation, personal, bodily, or mental injury, economic loss or any damage to you,
your spouse, guests, unborn child, or relatives resulting from any negligence of Peak Performance
Fitness, LLC, or anyone acting on behalf of Peak Performance Fitness, LLC, whether related to
exercise or not.

You agree to indemnify, defend and hold Eric C. Emms, Individually, Peak Performance Fitness, LLC and
The Edge Gym harmless against any liability, damages, defense costs, including attorneys’ fees, or from
any other costs incurred in connection with claims for bodily injury, wrongful death or property damage
caused by your negligence or any other wrongful acts or omissions.

You further agree to hold harmless, defend and indemnify Eric C. Emms, Individually, Peak Performance
Fitness, LLC and The Edge Gym from all liability, damages, defense costs, including attorneys fees, or
from any other costs incurred in connection with claims for bodily injury, wrongful death or property
damage brought by you, your guests, or minors.

You understand and acknowledge that Eric C. Emms, Individually, Peak Performance Fitness, LLC and
The Edge Gym are providing recreational services and may not be held liable for defective products. By
signing below, you acknowledge and agree that you have read the foregoing and know of the nature
of the activities provided by Eric C. Emms and Peak Performance Fitness, LLC, and you agree to all
of the terms of this agreement, and acknowledge that you have received copies of the same.

This agreement constitutes the sole and entire agreement between Peak Performance Fitness, LLC, and
myself in regards to the personal training program described above. No other agreement exists between us
and Peak Performance Fitness, LLC, has made no representations to me, verbally or in writing, about such
personal training program except as stated herein.

Client signature: _________________________________________________________ Date signed:________________________

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Parent or Guardian:

On behalf of my minor child and myself, I agree to the Release of Liability/Assumption of Risk and
Applicable Law clauses in this agreement, and I agree to defend and indemnify Eric C. Emms,
Individually, and Peak Performance Fitness, LLC, to the fullest extent permitted by law for any claim
brought by my minor child against Eric C. Emms, Individually, and Peak Performance Fitness, LLC. I
also agree to pay any financial obligation that my minor child does not pay for any reason.
Peak Performance Fitness, LLC reserves the right to use any and all video or still photography taken during
sessions for marketing and advertising purposes at the discretion of Peak Performance Fitness, LLC.

Parent/Guardian printed name:___________________________________________________________

Parent/Guardian signature:______________________________________Date:___________________

Minor child’s name:____________________________________________________________________

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