There is an inherent risk of injury, whether caused by me or someone else, in the use of or presence of a Total Balance center, the
use of Total Balance' equipment and services, and participation in Total Balance' programs. This risk includes, but is not limited to (a}
injuries arising from the use of any of Total Balance centers or equipment, including any accidental or "slip and fall" injuries; (b)
injuries arising from participation In supervised or unsupervised activities and programs within an Total Balance center or outside an
Total Balance center, to the extent sponsored QT endorsed by Total Balance; (c) injuries or medical disorders resulting from exercise
at any Total Balance center Including, but not limited to heart attacks, strokes, heart stress, sprains, broken bones and tom muscles
or ligaments, and (d) Injuries resulting from the actions taken or decisions made regarding medical or survival procedures.
I understand and voluntarily accept this risk, I agree to specifically assume all risk of injuries, whether physical or mental, as well as
all risk of loss, theft or damage of personal property while I am using or present at any Total Balance center, using any lockers,
equipment or services at any Total Balance center or participating in Total Balance' programs, whether such programs take place
inside or outside of any Total Balance center. l waive any and all claims or actions that may arise against Total Balance, Inc., its
affiliates, subsidiaries, successors or assigns (collectively, "Total Balance as well as each party's owners, directors, employees or
volunteers as a result of any such injury, loss, theft or damage, including and without limitation, personal, bodily or mental injury,
economic loss or any damage resulting from the negligence of Total Balance or anyone else using an Total Balance center. If there is
any claim by anyone based on any injury, loss, theft, or damage that involves me, I agree to defend Total Balance against such claims
and and pay such parties for all expenses relating to the claim, and indemnity Total Balance for all obligations resulting from such
claims.
I have read the above thoroughly and understand the terms. My participation in the selected activities and well as my agreement to
the foregoing are both purely voluntary and I elect to do so ln spite of the risks.
IF PERSON IS UNDER 16 YEARS OF AGE, A PARENT OR LEGAL GUARDIAN MUST COMPLETE THE FOLLOWING:
I, the undersigned parent, or legal guardian of the participant, hereby execute the foregoing for and on behalf of the participate and
agree to find myself, the participant and any heirs, next of kin, assigns or personal representatives to such terms represent that l
have full legal authority to act for and on behalf of the participant, and I agree to Indemnify and hold harmless Total Balance for any
expenses, claims or liabilities that may arise as a result of any insufficiency of my full legal authority to execute the foregoing.
I understand that in the completion of this form my electronic signature is equivalent to my written signature.*
