Power Center Waiver

Your Name *
Your Name
Phone Number *
Phone Number
Please leave your cell phone number. This will be be tied to our mobile app to book classes.
If a friend sent you, let us know their name so we can hook them up!
Emergency Contact
Emergency Contact's Name
Emergency Contact's Name
Emergency Contact's Number
Emergency Contact's Number
Please let us no who to contact in case of an emergency.
Health Conditions *
Please check if you have any Health Conditions below. If none apply to you please check "None".
By signing this waiver, I agree to the terms and conditions listed below. *
In checking the box below, I agree that the Power Center is in no way responsible for any injuries occurred while training on my own whether being in my home or in a gym. I understand that training plan may be physically strenuous and I voluntarily participate in them with full knowledge that there is a risk of personal injury, property loss or death. I agree that neither I, my heirs, assigns or legal representatives will sue or make any other claims of any kind whatsoever against the Power Center, or its members for any personal injury, property damage/loss, or wrongful death, whether caused by negligence or otherwise. I, the undersigned participant, am hereby enrolling in a program of strenuous physical activity including but not limited to MMA workouts, Cross Training, Weight Lifting, General Sports Drills, Plyometric Movements, Aerobic Training, Contact Sports Training, Use of various type exercise equipment, offered by Power Center. I have been strongly encouraged to consult with my doctor prior to starting an exercise program or increasing the intensity of an existing program both in this document and by Power Center. I assume this responsibility as indicated by my below signature and if I chose to, will act on this advice prior to the implementation of a recommendation made byPower Center. I hereby affirm that, to the best of my knowledge, I do not suffer from any condition that would prevent or limit my participation in this or any fitness program offered by Power Center, and have not withheld any related information from Power Center. Or in the event that through screening, I have been determined to be other than apparently healthy, I have been given a physician's release, as required by The Power Center to exercise. I am taking no medications that may adversely affect my fitness activities, and this release, with or without physician's restrictions, has been given to Power Center In addition, I acknowledge that if my health changes, it is my responsibility to recognize the change and seek medical advice to help me decide if my continued participation in the Fitness Program or any part of the Fitness Program is still right for me. I fully understand that I may injure myself as a result of my participation in Power Center's Fitness Program and I hereby release Power Center its board, employees and agents, from any liability now or in the future for any injury, including but not limited to heart attacks, death , muscle strains, pulls or tears, broken bones, shin splints, heat prostration, knee/lower back/foot injuries and any other illness, soreness or injury however caused, occurring during, or after my participation in the Fitness Program offered unless caused by the trainer's recklessness or intentional misconduct. In consideration of my participation in Power Center Fitness Program, I, for myself, my personal representatives, administrators, heirs and assigns, hereby holds harmless the Power Center its Board, employees and agents, from any claims, demands, and causes of action, including reasonable legal expenses and attorney's fees, arising from my participation in the Fitness Program unless caused by the trainer's recklessness or intentional misconduct. I hereby affirm that I have read, have been honest with Power Center, and fully understand the above information; I have been given the opportunity to present questions in all related matters, and am willing to participate. I agree to subscribe to the Power Center's newsletter that will be delivered via email. I understand that I can understand that I can unsubscribe at any time that I choose.
Date *