Personal Training Information Name * First Name Last Name Email * Membership Selection Single Session Head Trainer (Member) Single Session Personal Trainer (Member) Single Session Head Trainer (Non-Member) Single Session Personal Trainer (Non-Member) 10 Pack Head Trainer (Member) 10 Pack Personal Trainer (Member) 10 Pack Head Trainer (Non-Member) 10 Pack Personal Trainer (Non-Member) Billing Information Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Credit Card Number * * Credit Card Expiration * CVV Liability Waiver Liability Waiver * I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. NOTICE: THIS IS A LEGALLY BINDING AGREEMENT. Read this document in its entirety. By signing this agreement, you give up your right to bring a court action to recover compensation or obtain any other remedy for any personal injury or property damage arising out of your usage or participation in programs or membership at NEW CANAAN RACQUET CLUB/ HALO (“Company”) now or at any time in the future. 1. Participation in the Company fitness activities comes with inherent risks. I have full knowledge and understanding of the inherent risks associated with participation in the Company fitness programs and facilities, including but in no way limited to: (1) slips, trips, and falls, (2) athletic injuries, and (3) illness, including exposure to and infection with viruses or bacteria. The risk of injury from the activities involved in the program is significant, including the potential for permanent paralysis and death, and while particular skills, equipment, and personal discipline is offered by the Company and may reduce this risk, the risk of serious injury does exist; I further acknowledge that the preceding list is not inclusive of all possible risks associated with fitness program participation and facility use and that said list in no way limits the operation of this Agreement; 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE Company or any of the “Releasees” identified below and I fully assume responsibility for determining my own fitness to participate and for my participation: and, 3. I willingly agree to comply with the stated and customary terms and all consequences thereof and conditions for participation as in effect from time to time. If, however, I observe any unusual significant hazard of physical condition or response during my presence or participation, I will remove myself from participation and bring such to the attention of the Company immediately; 4. I hereby understand that the Company, staff or other participants may photograph, video or otherwise record Activities and place such photographs and videos on its Website, social media or on promotional materials. I hereby consent to the use of my image that may appear in any such photograph or video. 5. CORONAVIRUS / COVID-19 WARNING, DISCLAIMER, AND CUSTOMER WARRANT Coronavirus, COVID-19 is an extremely contagious virus that spreads easily through person-to-person contact. COVID-19 can lead to severe illness, personal injury, permanent disability, and death. Participating in Company programs or accessing Company facilities could increase the risk of contracting COVID-19. Company in no way warrants that COVID-19 infection will not occur through participation in Company programs of accessing Company facilities. The undersigned hereby agrees, represents, and warrants that neither the undersigned nor such participating children shall visit or utilize the facilities, services, and programs of Company (other than any exclusively online services and programs) within 5 days after recovery from COVID-9 or after exposure to any person who has a suspected or confirmed case of COVID-19. The undersigned hereby agrees, represents, and warrants that neither the undersigned nor such participating children shall visit or utilize the facilities, services, and programs of Company if he or she (i) experiences symptoms of COVID-19, including, without limitation, fever, cough or shortness of breath, or (ii) has a suspected or diagnosed/confirmed case of COVID-19. The undersigned agrees to notify Company immediately if he or she believes that any of the foregoing access/use restrictions may apply. 6. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS the Company and its members, managers, officers, contractors, agents and/or employees, other participants, sponsoring agencies, sponsors advertisers, and if applicable, owners and lessors of premises used for the activity (collectively the “Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, including but not limited to COVID-19 RELATED INJURY, DISABILITY OR DEATH, or loss or damage to person or property, WHETHER ARISING FROM OR CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, TO THE FULLEST EXTENT PERMITTED BY LAW. This Permission is our entire agreement regarding the subject matter hereof, will be governed by the laws of the State of Connecticut, any action relating hereto must be brought in courts located in Fairfield County, Connecticut, and this Permission may only be amended by a further writing signed by me and the Company I acknowledge that I have read and understand the terms of this waiver. Electronic Signature Agreement * By typing your name below and submitting this form, you acknowledge and agree that your typed name constitutes your electronic signature. You further confirm that you are entering into a legally binding agreement and consent to the Terms and Conditions of this document. Your electronic signature is legally valid and enforceable under the ESIGN Act (U.S.) or applicable electronic signature laws. By typing your name, you agree to be bound by the terms of this agreement as if you had signed it in writing. Full Name (Typed): * First Name Last Name Personal Training Sign Up