WHEEL HOUSE PARENTAL/LEGAL GUARDIAN CONSENT
• Medical Recommendations. Parent and/or legal guardian of minor participant in any Wheel House indoor cycling, yoga, or any other class, activity or event (hereafter, “Participant”) should consult with his or her physician or have a physical examination before using any of Wheel House facilities or enrolling in any of Wheel House’s classes, especially if Participant has a history of heart disease, high blood pressure or other chronic illness, or is unaccustomed to physical exertion or has other physical limitations.
• Activity Risk. Any strenuous athletic or physical activity involves certain risks. Parent and/or legal guardian of minor participant and his or her guests assume the risk of any and all accidents or injuries of any kind that may be sustained by, or in connection with, use of Wheel House facilities. Wheel House cannot guarantee that any facility or equipment is free of risk. Participant agrees to use care in the use of facilities, equipment and services and to protect against accidents by other Participants.
• Medical Disclaimer. Parent and/or legal guardian of minor participant has been informed and acknowledges that Wheel House makes no claims as to medical results that can or may be obtained through use of Wheel House facilities, equipment or services. Wheel House has neither suggested nor will suggest any medical treatment to Participant. Only licensed medical professionals are qualified to give medical advice. Participant is instructed not to act on the advice given by any unlicensed employee unless such advice has been verified by Participant’s licensed physician.
• Participant’s Health Warranty. Parent and/or legal guardian of minor participant represents that: (i) there are no medical or physical conditions that would preclude his or her use of Wheel House facilities; (ii) he or she has not been instructed by any physician not to use Wheel House; and (iii) he or she is in good health and has no disability, impairment, injury, disease or ailment preventing him or her from engaging in active or passive exercise or which could cause increased risk of injury or adverse health consequences as a result of exercise.
• Participant Release and Indemnity. By signing this Agreement and/or by attending classes or otherwise participating in Wheel House activities, Parent and/or legal guardian of minor participant hereby acknowledges and agrees that there are inherent risks in indoor cycling and exercise, and in using the equipment associated with Wheel House’s classes or instruction. Participant assumes full responsibility for his or her use of Wheel House’s facilities and shall indemnify Wheel House and its Board of Directors, shareholders, affiliates, agents, consultants and employees, against any and all liability arising out of the use of the facilities. Additionally, Parent and/or legal guardian of minor participant and his or her guests shall hold Wheel House harmless from any loss, theft, cost, claim, injury, damage or liability incurred as a result of studio use and activities.
• Parent and/or legal guardian of minor participant understands that by signing below, he or she agrees to indemnify Wheel House and its shareholders, affiliates, agents and employees, against any and all liability to him or herself and child arising out of any use of the facility. _______ (Initial here)
• Parent and/or legal guardian affirms that child is at least 13 years of age, 4’ 10” tall and weighs at least 100 pounds as required to participate in any Wheel House class, activity and/or event. _________ (Initial here)
• Parent and/or legal guardian agrees to renew consent as may be required by Wheel House. _________ (Initial) _____________________________________________________ Date:_____________, 20__________ Signature
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Parent/Legal Guardian Name/ Minor Name
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Email
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Emergency Contact Name & Phone Number
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Mailing Address City State Zip
