Free Trial Class

Golden Horde Studio Liability Waiver

Name: {name}

Phone Number: {phone}

Date of Birth: {dob}

Adress:  {address}

Emergency Contact Name: {contact_name}

Emergency Contact Number: {contact_phone}

Are you over 18 years old? Yes No

I am voluntarily participating in physical exercise that can be strenuous and subject to risk of serious injury during PRIVATE OR GROUP TRAINING. Golden Horde Studio urges you to obtain a physical examination from a doctor before beginning any exercise or training program. You agree that by participating in these physical exercise sessions or personal training activities, is at your own risk. I recognize that exercise is not without some risk to the musculoskeletal system (e.g. sprain, strain) and cardiorespiratory system (e.g. dizziness, fainting, abnormal heartbeat, discomfort in breathing, abnormal blood pressure response, and in rare instances, heart attack or stroke). I acknowledge that not all risks can be known in advance.

I HEREBY, for myself, my heirs, executors, administrators, assigns, or personal representatives (hereinafter collectively, “Releasor,” “I” or “me”, which terms shall also include Releasor’s parents or guardian if Releasor is under 18 years of age), knowingly and voluntarily enter into this WAIVER AND RELEASE OF LIABILITY and hereby waive any and all rights, claims or causes of action of any kind arising out of my participation in the Activity.

I HEREBY release and forever discharge Golden Horde Studio, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns (collectively “Releasees”), from any physical or psychological injury that I may suffer as a direct result of my participation in the aforementioned Activity.
I FURTHER AGREE to indemnify, defend and hold harmless the Releasees against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney fees and any related costs.

I FURTHER ACKNOWLEDGE that Releasees are not responsible for errors, omissions, acts or failures to act of any party or entity conducting a specific event or activity on behalf of Releasees. In the event that I should require medical care or treatment, I authorize Golden Horde Studio to provide all emergency medical care deemed necessary, including but not limited to, first aid, CPR, the use of AEDs, emergency medical transport, and sharing of medical information with medical personnel.

I further agree to assume all costs involved and agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance. In the event that any damage to equipment, field or facilities occurs as a result of my or my family’s or my agent’s willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any such actions of neglect or recklessness. Both participant and Golden Horde Studio agree that this agreement is clear and unambiguous as to its terms, and that no other evidence shall be used or admitted altering or explaining the terms of this agreement, but that it will be interpreted based on the language in accordance with the purposes for which it is entered into.

RISK WARNING AND LIABILITY EXCLUSION BETWEEN YOU AND GOLDEN HORDE STUDIO (TRADING AS GOLDEN HORDE PRODUCTIONS) 1. I agree that the Company, as a supplier of recreational services, will supply services to me including, but not limited to, gym studio, fitness equipment, fitness classes and/or training  programs ('the recreational services']; 2. acknowledge that whilst the Company, its officers, employees, servants or agents take measures to make the recreational services as safe as possible, there is a risk that I could be  personally injured as a result of my use and/or participation in and/or reliance on the recreational services; 3. understand that any personal injury may result from my actions, the actions of others or equipment failure, and may be life threatening or result in severe or permanent disability  or death; 4. agree that I will, at my own risk, use and/or participate in and/or rely upon the recreational services; 5. agree that the Company, its officers, employees, servants or agents will not be liable to me or my dependents, for personal injury or death suffered by me due to the: 5.1 recreational services not being supplied with due care and skill or not being reasonably fit for their purpose or for breach of any other consumer guarantees applied by the  Australian Consumer Law of this State; and/or  5.2 negligence, breach of contract and/or breach of statutory duty of the Company; 6. agree that I will indemnify the Company, its officers, employees, servants or agents for and against all liability to me or my dependents, for personal injury suffered by me due to the; 6.1 recreational services not being supplied with due care and skill or not being reasonably fit for their purpose or for breach of any other consumer guarantees applied by the  Australian Consumer Law of this state; and/or  6.2 negligence, breach of contract and/or breach of statutory duty of the Company; 7. understand that this Risk Warning and Liability Exclusion is not intended to exclude, restrict or modify liability which cannot lawfully be excluded, restricted or modified; and 8. acknowledge that this Risk Warning and Liability Exclusion is governed by the laws of the State in which it is accepted. I have read this Risk Warning and Liability Exclusion, understand its content, and have accepted below acknowledging this in accordance with my own free will.

I hereby grant Golden Horde Studio permission to use my likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web- based publications, without payment or other consideration.
I understand and agree that all photos will become the property of Golden Horde Studio and will not be returned.
I hereby irrevocably authorize Golden Horde Studio to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo.
I hereby hold harmless, release, and forever discharge Golden Horde Studio from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.
I HAVE READ AND UNDERSTAND THE ABOVE PHOTO RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENTS/GUARDIANS AS EVIDENCED BY THEIR SIGNATURES BELOW. I ACCEPT:

This screening does not provide advice on a particular matter, nor does it substitute for advice from an appropriately qualified medical professional. No warranty of safety should result  from its use.The screening system in no way guarantees against injury or death. No responsibility or liability whatsoever can be accepted by Golden Horde Studio for any loss,  damage or injury that may arise from any person acting on any statement or information contained in this tool.

Screening Questions

1. Has your medical practitioner ever told you that you have a heart condition or have you ever suffered a stroke? 
2. Do you ever experience unexplained pains or discomfort in your chest at rest or during physical activity/exercise?
3. Do you ever feel faint, dizzy or lose balance during physical activity/exercise?
4. Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?
5. If you have diabetes (type l or type ll) have you had trouble controlling your blood sugar (glucose) in the last 3 months?
6. Do you have any diagnosed muscle, bone or joint problems that you have been told could be made worse by participating in physical activity/exercise?
7. Do you have any other conditions that may require special consideration for you to exercise?

Screening Outcomes

IF YOU ANSWERED YES to any of the 7 questions, please seek guidance from an appropriate allied health professional or medical practitioner prior to undertaking exercise. OR  I acknowledge that I am currently under the supervision of a medical practitioner who has approved my participation in an exercise program.You meet the criteria to proceed ALL NO ANSWERS IF YOU ANSWERED 'NO' to all of the 7 questions, and you have no other concerns about your health, you may proceed to undertake light-moderate intensity physical activity/exercise.  You meet the criteria to proceed