Health & Fitness Liability Waiver/Informed Consent Form
I have voluntarily enrolled in a class offered at Immersive van Gogh. I recognize that the class will involve physical activity including, but not limited to, muscle strength, endurance training, and other various fitness activities. I also recognize that the space will have moving pictures and music which may cause imbalance or distraction during class.
I hereby affirm that I am in good physical condition and do not suffer from any known disability or condition which would prevent or limit my participation in this exercise class. I am aware that an examination by a physician should be obtained by anyone prior to commencing a fitness and/or exercise class, or initiating a substantial change in the amount of regular physical activity performed. If I have chosen not to obtain a physician’s consent prior to beginning this fitness class, I hereby agree that I am doing so solely at my own risk. I understand that it is my sole responsibility to participate in exercises that are appropriate for the current status of my health.
I acknowledge that there will be photos taken during the class that can be used by Lighthouse Immersive Inc. and its affiliates. I give my consent for these photos to be taken and used. I agree not to hold Lighthouse Immersive Inc and its affiliates responsible for the actions or omissions of the other class participants.
I have been informed, understand, and am aware that strength, flexibility, and aerobic exercise are potentially hazardous activities. I also have been informed, understand, and am aware that fitness activities involve a risk of injury and that I am voluntarily participating in these activities with full knowledge, understanding, and appreciation of the dangers involved.
I hereby waive and release Lighthouse Immersive Inc. and its affiliates from any and all claims, costs, liability and expense for any injury, loss or damage whether known, anticipated or unanticipated arising from my voluntary participation and enrollment.
I have been informed, understand, and am aware that participants must be 12 years of age or older and that minors must be accompanied by an adult. I also have been informed, understand, and am aware that tickets are non-refundable and no free or discounted tickets available for classes to students/seniors or children.
Release, Waiver of Liability, Assumption of Risk, and Indemnity Agreement:
I fully understand that participation in the Activities includes, without limitation, strenuous physical and mental activities and exercises, participating in the Activities with other participants, contact with unidentified and unfamiliar persons, participating in the Activities in new and unfamiliar places and manners, exposure to risks in the areas in which the Activities are conducted, and exposure to communicable diseases (including COVID-19 risks, as further detailed above in COVID-19 Terms and Conditions). I fully understand that the Activities can be HAZARDOUS, and involve known risks and unanticipated risks which could result in BODILY OR MENTAL INJURY, ILLNESS, DEATH, DAMAGE OR LOSS to myself, my property, and to other third parties and their property, which may be caused by my own actions or inactions, those of others participating in the Activities, the locations, places and/or buildings at, on or in which the Activities take place, the conditions at, on and in which the Activities take place (including equipment, ventilation and surfacing for the Activities), or the negligence or misconduct of any of the “Releasees” named below; and I fully accept and ASSUME ALL SUCH RISKS and all responsibility for losses, costs, and damages I or any third parties incur as a result of my participation in the Activities, including property theft. I represent that I understand the nature of the Activities. I further represent that I am participating in the Activities voluntarily, and that I am in good health, physically and mentally fit and otherwise prepared and able to participate in the Activities. I will discontinue my participation in the Activities if I believe at any time my participation poses a threat to myself or any third party. If I have any injury or condition that potentially affects my participation in the Activities, I will consult with my physician or other applicable provider regarding my participation, and follow all applicable provider instructions, which is my sole responsibility.
I, on behalf of myself and anyone who obtains any rights from or through me, hereby forever and irrevocably release and discharge Lighthouse Immersive; the owners, lessors, lessees and any other individual or entity with any interest in the locations, places and/or buildings at, on or in which the Activities take place; any individuals or entities involved in any capacity with the Activities (including, without limitation, any technology applications and platforms facilitating the Activities in any manner); any sponsors, advertisers or promoters of any of the foregoing; any of the respective parents, subsidiaries, affiliates, partners, members, owners, agents, contractors, subcontractors, administrators, licensees, designees, insurers, personal and legal representatives, successors and assigns of each of the foregoing; other participants in the Activities; and any director, officer, member, manager, partner, volunteer, employee, representative or agent of any of the foregoing (each a “Releasee” herein) from any and all liabilities, claims, demands, losses, damages, costs or expenses (including, without limitation, attorneys’ fees and costs) (collectively, “Losses”) arising out of or in any way related to my participation in or attendance at the Activities; my attendance at the locations, places and/or buildings at, on or in which the Activities take place; or any first aid, treatment or any like service rendered in connection with the Activities, including, but not limited to, Losses (including, without limitation, Losses from BODILY OR MENTAL INJURY, ILLNESS OR DEATH) caused or alleged to be CAUSED IN WHOLE OR IN PART BY (i) THE NEGLIGENCE OR MISCONDUCT of any Releasee or otherwise, including negligent rescue operations; (ii) any claim, action, suit or demand brought by any third party against any Releasee by reason of or in connection with my participation in or attendance at the Activities, or my attendance at the locations, places and/or buildings at, on or in which the Activities take place; (iii) the voluntary disclosure of my medical information; (iii) invasion of privacy, right of publicity, defamation, libel, slander, copyright infringement, trademark infringement, or any other claims or causes of action arising out of the use of my name, image, likeness, voice and/or other personal attribute(s) or other personal information (collectively, my “Personal Attributes”). I further covenant and agree not to sue any Releasee or cause any Releasee to be sued regarding any matter released above, and to indemnify and hold harmless each Releasee from and against any Loss regarding any matter within the scope of this Release, Waiver of Liability, Assumption of Risk, and Indemnity Agreement.
I ACKNOWLEDGE THAT I HAVE THOROUGHLY READ THIS FORM IN ITS ENTIRETY AND FULLY UNDERSTAND IT. I UNDERSTAND THAT IT CONTAINS A RELEASE OF LIABILITY. BY AGREEING TO THIS DOCUMENT UPON PURCHASE, I AM WAIVING CERTAIN RIGHTS I OR MY SUCCESSORS MIGHT HAVE TO BRING A LEGAL ACTION OR ASSERT A CLAIM AGAINST LIGHTHOUSE IMMERSIVE INC. AND ITS AFFILIATES.