Release of Liability Terms

All Clients of MBM, LLC. are required to sign this form



NAME: _______________________________________________________________________________


DATE OF BIRTH: month______ / day_____ / year ______ Phone Number_____________________

TO: MBM, LLC.  I am aware that, in addition to the usual dangers and risks associated with fitness training and exercise, certain additional dangers and risks are present within these activities including , but not limited to, occasional hazardous conditions, occasional hazardous equipment conditions, potential for injury and/or death as a result of health related incidents, such as heart related injuries, stroke, and any and all other conditions, medically related or not, potential injury and/or death as a result of participating in physical activities; and I freely accept and assume all such dangers and risks and the possibility of personal injury, death, property damage or loss resulting there from my contact, of any kind with MBM, LLC., it’s shareholders, directors, officers, employees, agents, and representatives. Further, I expressly indicate to MBM, LLC., that I have no known medical conditions that may impair my ability to participate in the activities. Further, I have contacted my physician regarding participating in the activities and I affirmatively state herein, that I have been cleared from any health risks. In consideration of MBM, LLC. permitting me to participate in the exercise program, I hereby agree as follows:

I. TO WAIVE ANY AND ALL CLAIMS that I may have against MBM, LLC. and it’s shareholders, directors, officers, employees, agents, and representatives (all of whom shall now be referred to as the releasees)

II. TO RELEASE THE RELEASEES FROM ANY AND ALL LIABILITY for any loss, damage, injury, or expense that I may suffer, or that my next of kin may suffer, as a result of my participation in any activity due to any cause whatsoever, including any negligence on the part of the releasees

III. TO HOLD HARMLESS AND INDEMNIFY THE RELEASEES for any and all liability for any property damage, loss, or personal injury to any third party, resulting from my participation in the activity.

IV. THAT this Release Of Liability Agreement shall be effective and fully binding upon my heirs, next of kin, executors, administrators, and assigns in the event of my death.

I am of the full age of 18 years, and have been given ample time to read this agreement. I have read and fully understand this Release Of Liability Agreement, and am aware that by signing this Release Of Liability Agreement I am waiving certain legal rights which I or my heirs, next of kin, executors, administrators, and assigns may have against the releasees. I certify that all personal information provided on this Release Of Liability Agreement is true.


CLIENT’S SIGNATURE  ______________________________________________    DATE  ___________________________________