AUTOMATIC PAYMENT AUTHORIZATION, I a PWC Go Member at Personalized Wellness Center), hereby authorize Personalized Wellness Center to charge my credit card or debit card for any and all payments as indicated above. I further authorize my credit card company to make payments to any of the entities stated above by the method indicated in this agreement to post on my account. Charges will appear on your account from: Personalized Wellness Center
Informed Consent Waiver, Release and Hold Harmless Agreement for Fitness Program Participant
1) I, the undersigned participant, am hereby enrolling in a program of strenuous physical activity including but not limited to, Cross Training, Weight Lifting, General Sports Drills, Plyometric Movements, Aerobic Training, Contact Sport Training, I have been strongly encouraged to consult with my doctor prior to starting an exercise program or increasing the intensity of an existing program both in this document and by PWC. I assume this responsibility as indicated by my acceptance of the terms and conditions and if I chose to, will act on this advice prior to the implementation of a recommendation made by PWC. I herby affirm that, to the best of my knowledge, I do not suffer from any condition that would prevent or limit my participation in this or any Fitness Program offered by PWC, and have not withheld any related information from PWC.
2) Or in the event that through screening, I have been determined to be other than apparently healthy, I have been given a physician's release, as required by PWC to exercise. I am taking no medications that may adversely affect my fitness activities, and this release, with or without physician's restrictions, has been given to PWC. In addition, I acknowledge that if my health changes, it is my responsibility to recognize the change and seek medical advice to help me decide if my continued participation in the Fitness Program or any part of the Fitness Program is still right for me.
3) I fully understand that I may injure myself as a result of my participation in PWC's Fitness Program and I hereby release PWC its board, employees and agents, from any liability now or in the future for any injury, including but not limited to heart attacks, death , muscle strains, pulls or tears, broken bones, shin splints, heat prostration, knee/lower back/foot injuries and any other illness, soreness or injury however caused, occurring during, or after my participation in the Fitness Program offered unless caused by the trainer's recklessness or intentional misconduct.
4) In consideration of my participation in PWC's Fitness Program, I, for myself, my personal representatives, administrators, heirs and assigns, hereby holds harmless PWC, its Board, employees and agents, from any claims, demands, and causes of action, including reasonable legal expenses and attorney's fees, arising from my participation in the Fitness Program unless caused by the trainer's recklessness or intentional misconduct. I hereby affirm that I have read, have been honest with PWC, and fully understand the above information; I have been given the opportunity to present questions in all related matters, and am willing to participate.