Huszka, LLC (hereinafter referred to as Huszka Weightlifting Club) Waiver Form

1. Participant's Full Name ___________________________

2. Participant's Date of Birth _________________________

3. Participant's Address _____________________________

4. Participant's Phone Number _______________________

5. Parental Assumption of Risk & Conduct: Parents, please note Huszka Weightlifting Club is not a

licensed childcare facility. You assume complete and total responsibility for your children at all

times. Children and individuals not participating in class are not allowed to access, or use any of the equipment. NO EXCEPTIONS.

I have read and agree to the terms and conditions stated above.

6. Are you over 18 years of age? (If no, a parent or guardian signature is required)

Yes ____ No ____

7. Parent/Guardian Full Name (if participant is under 18) _________________

8. Parent/Guardian Email (if participant is under 18) ______________________

9. Emergency Contact Name ___________

10. Emergency Contact Phone Number _______________

11. Do you have any pre-existing medical conditions or injuries that may affect your ability to lift weights? If yes, please specify.

Yes_________ No _________

12. In consideration of my participating in this weightlifting and exercise program, I agree to release and discharge Huszka Weightlifting Club and any of its owners, officers, employees, contractors, volunteers and supervisors, from any injuries or liability sustained by me as a result of participation in this program.

I agree to indemnify and hold harmless, Huszka Weightlifting Club, and any of its supervisors, employees, contractors and volunteers against any liability incurred as a result of such injury or loss. Fitness activities and weightlifting programs require that I be in good health and have no condition that could endanger my well-being through participation. I will notify Huszka Weightlifting Club of any such defects in writing prior to enrolling in this program.

This agreement applies to 1) personal injury (including death) from accidents or illness arising directly or indirectly from participation in activities directed, suggested or planned by Huszka Weightlifting Club including, but not limited to, organized activities, classes, instructions, observation, related activities in a non-supervised setting, and use of facilities, premises, or equipment; and 2) any and all claims resulting from the damage to, loss or theft of property.

Assumption of Inherent Risks: Fitness and weightlifting activities, by their very nature, carry with them certain inherent risks that cannot be eliminated regardless of the care the fitness trainer takes to prevent injuries. The training activities offered by Huszka Weightlifting Club provide for activities such as Olympic style weightlifting and associates training exercises, resistance training, calisthenics such a push-ups, agility maneuvers, mild forms of plyometric, and flexibility exercises. Some of these activities involve strenuous exertions of strength using various muscle groups, some involve quick movements involving speed and change of directions and others involve sustained physical activity that places stress on the cardiovascular system. In addition, some exercises involve equipment such as but not limited to: barbells, power racks, dumbbells, bumper/rubber plates, jerk blocks, flat bench press and incline bench press and other props - all of which have the potential for malfunctioning and causing injury.

The specific risks vary from one to another, but in each activity, the risk range from 1) occasionally occurring minor injuries such as calluses on hands, scratches, bruises, muscle strains and sprains to 2) rarely occurring major injuries such as ligament damage, damage to the joints, broken bones, or injuries to the back, concussions and heart attacks to 3) the very rare occurrence of the catastrophic injuries such including paralysis and death.

______ Acknowledgement and Understanding: I have read this assumption of risks and fully understand its terms.

13. I acknowledge that I am signing the agreement freely and voluntarily and intend by submission to signify a complete assumption of the inherent risks in any way associated with the intense workouts or training program offered by Huszka Weightlifting Club to the greatest extent allowed by law in the state of TEXAS.

___________________________________________________________________

Participant's Signature (for adults) or Parent/Guardian Signature (for minors)

14. Date __________________________