Gym Liability Waiver

Participant Information

Participant Name(Required)
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Address(Required)

Parent/Guardian Information (if participant is under 18)

Name
Address

Emergency Contact Information

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Liability Waiver and Release

In consideration for being allowed access to and use of the gym facilities at Shepherdsville City Hall located at 634 Conestoga Parkway, Shepherdsville, KY 40165 (“City Gym”) provided by the City of Shepherdsville, Kentucky for the purposes of athletics, physical fitness, sports, exercise, training, and recreational activities, etc. (“Activities”), I, on behalf of myself, my heirs, executors, agents, administrators, assigns, estate, and all other persons claiming through me, do hereby agree to RELEASE AND HOLD HARMLESS the City of Shepherdsville, its elected and appointed officials, officers, employees, agents, affiliates, volunteers, participants, and any and all other persons or entities acting in any capacity on its behalf (“City”) as follows:

  1. I understand that physical activity, by its very nature, carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The City Gym has facilities for and provides for activities such as running, basketball, and sporting activities. Some of these involve strenuous exertions of strength using various muscle groups, some involve quick movements involving speed and change of direction, and others involve sustained physical activity which places stress on the cardiovascular system. The specific risks vary from one activity to another, but the risks range from minor injuries such as scratches, bruises, and sprains to major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks, and concussions to catastrophic injuries including paralysis and death. In addition, I understand that participation in Activities involves risks incidental thereto, including, but not limited to, the possible reckless conduct of other participants; exposure to communicable and infectious diseases, including, for example, HIV, hepatitis, and COVID-19, which can lead to illness or death; and risk of theft, loss, or damage to my personal property, which may occur at any time arising out, related to, and/or resulting from my use of the City Gym and/or my participation in said Activities.
  2. My choice to use the City Gym and participate in Activities is made voluntarily, for my own personal benefit, and with knowledge of the risks and dangers. I expressly and voluntarily consent and agree to assume all risks of use of the City Gym and/or participation in Activities and accept full responsibility for all damages and/or injury that may relate to, arise out of, and/or result from my use of the City Gym and/ or my participation in Activities.
  3. I hereby voluntarily release, waive, discharge, and agree to indemnify and hold harmless the City from any and all claims, demands, actions, or causes of action arising out of, related to, and/or resulting from, my use of the City Gym and/or my participation in Activities, including, but not limited to, any such claims, demands, actions, or causes of action which allege negligence, negligent acts, and/or negligent omissions on the part of the City.
  4. This waiver and release includes, but shall not be limited to, waiver of the right to initiate, proceed with, and/or participate in any state or federal lawsuit, any administrative complaints, statutory or common law claims, or civil rights charges against the City, resulting from, arising out of, and/or related to, my use of the City Gym and/or my participation in Activities, including but not limited to any such claims, demands, actions, or causes of action which allege negligence, negligent acts, and/or negligent omissions on the part of the City.
  5. I expressly agree to defend, protect, indemnify, and hold harmless the City from any and all claims, demands, actions, or causes of action, including attorneys’ fees, that might hereafter be asserted against the City, resulting from, arising out of, and/or related to, my use of the City Gym and/or my participation in Activities, including but not limited to, any such claims, demands, actions, or causes of action which allege negligence, negligent acts, and/or negligent omissions on the part of the City.
  6. I understand that the City does not carry participant insurance, and that I will be solely responsible for any medical, health, or personal injury costs relating to, resulting from, and/or arising out of, my use of the City Gym and/or my participation in Activities.
  7. This Agreement represents the complete understanding between the parties regarding these issues addressed herein and no oral representations, statements, or inducements have been made apart from this Agreement with respect to the issues herein. If any provision of this Agreement is held to be unlawful, void, voidable, or for any reason unenforceable, then that provision shall be deemed severable from this Agreement and shall not affect the validity and/or enforceability of any remaining provisions.
  8. I have received a copy of the Shepherdsville City Gym Rules (“Rules”) and agree to abide by the Rules and all City policies, procedures, guidelines, and other safety procedures. Failure to do so may result in suspension of my privilege to use the City Gym.

BY SIGNING THIS AGREEMENT, I ACKNOWLEDGE THAT I HAVE CAREFULLY READ AND FULLY UNDERSTAND THE TERMS OF THIS AGREEMENT, AGREE TO BE BOUND THERETO, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENTS.

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(PARENT’S SIGNATURE IF PARTICIPANT IS UNDER 18)

I attest that I am the legal parent/guardian of the above-named Participant and that I, on behalf of myself, my spouse, my children (including, but no limited to, the above-named Participant), my parents, heirs, assigns, personal representative, and estate have read and understood the terms of this Agreement, agree to be bound thereto, and sign in freely and voluntarily without any inducements.

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