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| INFORMED CONSENT & RELEASE OF LIABILITY FOR GUESTS Non-member temporary participants of the Schaumburg Corporate Fitness Center |
| Informed Consent I, the undersigned, have requested guest-use privileges at The Manufacturer�s Life Insurance Company USA�s Health and Fitness Center, known as the Schaumburg Corporate Fitness Center. I understand there are possibilities of injury or other complications, including but not limited to musculoskeletal injuries, cardiovascular trauma, neurological impairment, heart attack, even death, which may occur while using The Manufacturer�s Life Insurance Company USA�s Health and Fitness Center facilities. I voluntarily agree to assume all risks associated with my participation, at using The Manufacturer�s Life Insurance Company USA�s Health and Fitness Center. I understand that I am solely responsible for limiting my exercise to a level appropriate for me. I certify that to the best of my knowledge, I have no physical impediments or medical conditions, which would limit or should prevent my use of the fitness facility. I understand that it is in my best interest to consult with a physician prior to initiating an exercise program. I understand that The Manufacturer�s Life Insurance Company USA (MANULIFE) or its representative, Health Fitness Corporation may revoke my privileges to use the Fitness Center at any time, at their discretion. I agree to be bound by and obey all the rules of the using The Manufacturer�s Life Insurance Company USA, Health Fitness Corporation and the Fitness Center Staff in my use of the facilities. Release of Liability In consideration of being allowed to use The Manufacturer�s Life Insurance Company USA Health and Fitness Center and participate in Fitness Center sponsored programs or activities, I hereby release The Manufacturer�s Life Insurance Company USA and Health Fitness Corporation and their directors, officers, employees, agents, successors, and assigns from any and all claims, demands, actions, or causes of action whatsoever, and from any and all liability for any loss or property damage or personal injury of any kind, nature, or description, including death that may arise or be sustained by me, during or related to my use of The Manufacturer�s Life Insurance Company USA�s fitness facility. This release shall be binding upon my heirs, administrators, executors, and assigns. |
| I represent that I have read and understood this Informed Consent and Release of Liability and acknowledge that they are being relied on by The Manufacturer�s Life Insurance Company USA and Health Fitness Corporation in permitting me to use the Health and Fitness Center. I understand that at any time I may review this Informed Consent and Release of Liability by requesting a copy from the Ftness Center staff. |
| My signature below indicates that I have read, understood, and consent to all text herein. ______________________________ __________________________ Guest Name �Please Print Date ______________________________ ___________________________ Last 4 digits of Social Security Phone (Hm/ Wk- circle one) ______________________________ ___________________________ Home Address Company Employed by. ____________________________________ Signature |