WEST COAST UPA EVENT FORM

Athlete Information

Athlete's Name

Parent/Guardian Information

If under the age of 18

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Emergency Contact Information

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Divisions

Release of Liability *
In consideration of being allowed to participate in any way in this Powerlifting event sanctioned by the UPA , its related events and activities, I, the registrant, acknowledge, appreciate, and agree that: 1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and, 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and, 3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the USPA officials immediately; and, 4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS THE Meet Director/promoter, UPA and their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used for the activity ("Releasees"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT , FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

It is recommended that all members and guests consult their personal physician before undertaking any physical activity. Member stipulates that he or she is physically sound and that he or she has medical approval to proceed with a normal routine of exercise.Required AgreementsWaiver of LiabilityMEMBER ACKNOWLEDGES THAT THE USE OF AMERICAN IRON GYM’S FACILITIES, EQUIPMENT, MERCHANDISE, SERVICES AND PROGRAMS (INCLUDING PERSONAL TRAINING) INVOLVES AN INHERENT RISK OF PERSONAL INJURY TO MEMBER AND MEMBER’S GUESTS AND INVITEES. MEMBER VOLUNTARILY AGREES TO ASSUME ALL RISKS OF PERSONAL INJURY TO MEMBER, MEMBER’S SPOUSE, CHILDREN, UNBORN CHILDREN, OTHER FAMILY MEMBERS, GUESTS OR INVITEES AND WAIVES ANY AND ALL CLAIMS OR ACTIONS THAT MEMBER MAY HAVE AGAINST AMERICAN IRON GYM, ANY OF ITS PARENTS, SUBSIDIARIES OR OTHER AFFILIATES AND ANY OF THEIR RESPECTIVE OFFICERS, DIRECTORS, EMPLOYEES, AGENTS, SUCCESSORS AND ASSIGNS FOR ANY SUCH PERSONAL INJURY (AND NO SUCH PERSON OR ENTITY SHALL BE LIABLE TO MEMBER, MEMBER’S SPOUSE, CHILDREN, UNBORN CHILDREN, OTHER FAMILY MEMBERS, GUESTS OR INVITEES FOR ANY SUCH PERSONAL INJURY), INCLUDING, WITHOUT LIMITATION: (I) INJURIES ARISING FROM USE OF ANY EXERCISE EQUIPMENT, MACHINES OR PERSONAL TRAINING SERVICES; (II) INJURIES ARISING FROM PARTICIPATION IN SUPERVISED OR UNSUPERVISED ACTIVITIES AND PROGRAMS IN EXERCISE ROOMS, OUSIDE EXERCISE COURTS OR OTHER AREAS OF ANY AMERICAN IRON GYM, INJURIES ARISING FROM AMERICAN IRON GYM’S NEGLIGENCE, WHETHER DIRECT OR INDIRECT; (IV) INJURIES, DISEASE, INFECTION OR MEDICAL DISORDERS RESULTING FROM EXERCISING AT ANY AMERICAN IRON GYM, INCLUDING HEART ATTACKS, STROKES, HEAT STRESS, SPRAINS, BROKEN BONES AND TORN OR DAMAGED MUSCLES, LIGAMENTS OR TENDONS; AND (V) ACCIDENTAL INJURIES WITHIN ANY AMERICAN IRON GYM FACILITIES, INCLUDING LOCKER ROOMS, SHOWERS AND DRESSING ROOMS. MEMBER ALSO WAIVES ALL CLAIMS AGAINST AMERICAN IRON GYM, ANY OF ITS PARENTS, SUBSIDIARIES OR OTHER AFFILIATES AND ANY OF THEIR RESPECTIVE OFFICERS, DIRECTORS, EMPLOYEES, AGENTS, SUCCESSORS AND ASSIGNS FOR ANY CLAIMS MEMBER MAY HAVE UNDER ANY OF THE STATE’S CONSUMER PROTECTION STATUTES. THE PROVISIONS OF THIS PARAGRAPH SHALL SURVIVE THE TERMINATION OF THIS AGREEMENT AND MEMBER’S MEMBERSHIP.I have read and agree to the Waiver of Liability *Yes (By clicking YES, you are agreeing to the Waiver of Liability)ASSUMPTION OF RISK AND INDEMNIFICATIONMember acknowledges that (i) American Iron Gym does not manufacture any of the fitness or other equipment at its facilities and (ii) American Iron Gym does not manufacture any vitamins, food products, sports drinks, nutritional supplements or other products sold at its facilities; accordingly, neither American Iron Gym nor any of its parents, subsidiaries or other affiliates nor any of their respective officers, directors, employees, agents, successors or assigns shall be held liable for any such defective equipment or products. Member shall indemnify American Iron Gym, its parents, subsidiaries and other affiliates and each of their respective officers, directors, employees, agents, successors and assigns (an “Indemnified Party”) and save and hold each of them harmless against and pay on behalf of or reimburse any such indemnified party as and when incurred for any losses which such indemnified party may suffer, sustain or become subject to, as a result of, in connection with, relating or incidental to or by virtue of any claim that is the subject of the waiver set forth above. The provisions of this paragraph shall survive the termination of this Agreement and Member’s membership.I have read and agree to the Assumption of Risk and Indemnification *Yes (By clicking YES, you are agreeing to the Assumption of Risk and Indemnification) Parental/Guardian Consent: (To be completed and signed by parent/guardian forparticipants under 18 years of age). I certify that I am the parent or legal guardian of theabove participant and that I am entitled to his or her custody and control. I do hereby givepermission for the child to use the American Iron Gym Facility. I further certify that the child is in goodhealth and has no physical or other impediment which would endanger him or her whileusing the gym Facility. I realize that the child may be exposed to a risk of injury or death.I understand the dangers incidental to using the gym Facility and the need for safetyprecautions, and I have discussed these dangers and the need for safety precautions withthe child. I understand that there is NO CHILDCARE ON DUTY AT ANY TIME andthat the child must be accompanied by an adult at all times while in the Gym Facility.I have entered my legal name, relationship, and contact information in this profile.I have read, fully understand and accept this Release, Waiver of Liability andAssumption of Risk for the use of American Iron Gyms Facility onhis/her behalf.   BY CLICKING IN THE BELOW BOX "I AGREE WITH THE ABOVE iTEMS", i ACKNOWLEDGE THAT i HAVE READ AND AGREE TO THE TERMS OF THE LIABILITY RELEASE AND THIS SERVES AS MY SIGNATURE.