I agree to participate in one or more physical fitness program(s)/class(es) sponsored by PHAROS LLC, which may include, but not necessarily be limited to, WORK, BUILD, TRACK, FIGHT, RIDE, PREPARE, REPAIR, FLOW and/or training of any kind by any affiliate, subsidiary or partnership of PHAROS LLC. PHAROS has made me fully aware that the fitness programs/classes which PHAROS offers and in which I desire to participate are of a nature and kind that are extremely strenuous and can/may push me to the limits of my physical abilities. I the undersigned recognize and understand that the programs/classes are not without varying degrees of risk which may include, but are not limited to the following:
Injury to the musculoskeletal and/or cardio respiratory systems which can result in serious injury or death, injury or death due to negligence on the part of myself, my training partner, or other people around me, injury due to improper use or failure of equipment, or injury or death due to a medical condition, whether known or unknown by me. I am aware that any of these above mentioned risks may result in serious injury or death to myself and or my partner(s).
Because physical exercise can be strenuous and subject to risk of serious injury, PHAROS recommends I obtain a physical examination from a doctor before using any exercise equipment or participating in any exercise activity. I agree that by participating in physical exercise or training activities, I do so entirely at my own risk. Any recommendation for changes in diet including the use of food supplements, weight reduction and/or body building enhancement products are entirely my responsibility and I should consult a physician prior to undergoing any dietary or food supplement changes.
I willingly assume full responsibility for any and all risks that I am exposing myself to as a result of my participation in PHAROS programs/classes/treatments and accept full responsibility for any injury or death that may result from participation in any activity, class or physical fitness program. I herby certify that I know of no medical problems that would increase my risk of illness and injury as a result of participation in a fitness program designed by PHAROS. PHAROS informed me that there exists the possibility of adverse physical changes during an exercise program, and I fully understand the same. PHAROS informed me that these changes could include abnormal blood pressure, fainting, disorder of heart rhythm, stroke, and in very rare instances, heart attack or even death, and I fully understand the same. With my full understanding of the above information, I agree to assume any and all risk associated with my participation in PHAROS fitness programs/classes.
REPAIR SHOP SERVICES
If you choose to engage in Repair Shop Services, including massage, movement or chiropractic care, you agree to the following:
1. CONSENT TO TREATMENT: I give my permission to receive massage, chiropractic, or movement therapy. One of the treatments that may be employed under the Repair Shop is spinal and or extremity manipulative therapy. The undersigned requests and consents for therapists at Pharos to perform evaluation and treatment for all related conditions, whether pre-existing or current. The undersigned grants permission to undergo any diagnostic or therapeutic treatment recommended by the chiropractor including but not limited to physical, orthopedic, psychological, and neurological examinations, diagnostic imaging, chiropractic manipulation, myofascial release, strength and conditioning exercises, electrical muscle stimulation, first aid care, sports taping techniques and bracing.
2. I understand that Repair Shop services are not a substitute for traditional medical treatment or medications.
3. I understand that the Repair Shop team does not diagnose illnesses or injuries, or prescribe medications.
4. I have clearance from my physician to receive Repair Shop Services.
5. Some patients will feel some stiffness and soreness following the first few days of treatment.
I understand the risks associated with this kind of therapy include, but are not limited to:
• Superficial bruising • Short-term muscle soreness • Exacerbation of undiscovered injury.
I therefore release PHAROS and the individual therapist from all liability concerning these injuries that may occur during any session.
6. I understand the importance of informing my therapist of all medical conditions and medications I am taking, and to let the therapist know about any changes to these. I understand that there may be additional risks based on my physical condition.
7. I understand that it is my responsibility to inform my therapist of any discomfort I may feel during the session so he/she may adjust accordingly.
In full consideration of the above mentioned risks and hazards and in full consideration of the fact that I am willingly and voluntarily participating in the activities made available by PHAROS, and with my full understanding of all of the above, I hereby waive, release, remise and discharge PHAROS and its agents, officers, principals and employees and volunteers, of any and all liability, claims, demands, actions or rights of action, or damages of any kind related to, arising from, or in any way connected with, my participation in PHAROS fitness programs/classes, including those allegedly attributed to the negligent acts or omissions of the above mentioned parties. This agreement shall be binding upon me, my successors, representatives, heirs, executors, assigns, or transferees. If any portion of this agreement is held invalid, I agree that the remainder of the agreement shall remain in full legal force and effect.
If I am signing on behalf of a minor child, I also give full permission for any person connected with PHAROS to administer first aid deemed necessary, and in case of serious illness or injury, I give permission to call for medical and or surgical care for the child and to transport the child to a medical facility deemed necessary for the well being of the child.
Indemnification: I recognize that there is risk involved in the types of activities offered by PHAROS. Therefore I accept financial responsibility for any injury that I or the participant may cause either to him/herself or to any other participant due to his/her negligence. Should the above mentioned parties, or anyone acting on their behalf, be required to incur attorney’s fees and costs to enforce this agreement, I agree to reimburse them for such fees and costs. I further agree to indemnify and hold harmless PHAROS, their principals, agents, employees, and volunteers from liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in activities offered by PHAROS.
Use of picture(s)/film/likeness: I agree to allow PHAROS, its agents, officers, principals, employees and volunteers the picture(s), film and/or likeness of me for advertising purposes. In the event I choose not to allow the use of the same for said purpose, I agree that I must inform PHAROS of this in writing.
I have fully read and fully understand the foregoing assumption of risk, and release of liability and I understand that by signing it obligates me to indemnify the parties named for any liability for injury or death of any person and damage to property caused by my negligent or intentional act or omission. I understand that by signing this form I am waiving valuable legal rights.