Name * First Name Last Name Telephone * Country (###) ### #### Email * Address * What's your address Address 1 Address 2 City State/Province Zip/Postal Code Country Minor's First Name (if applicable) First Name Last Name Minor's First Name (if applicable) First Name Last Name I AGREEMENT OF RELEASE AND WAIVER OF LIABILITY * I hereby agree to the following: 1. That I am participating in fitness training offered by Sergio Seminario, at Provida Fitness, or alternate instructor during which I will receive instruction on physical fitness workouts. 2. I understand that it is my responsibility to consult with a physician prior to and regarding my participating in any physical fitness program or exercises at Provida Fitness. I represent and warrant that I am physically fit and I have no medical condition that would prevent my full participation in this program. 3. In consideration of being permitted to participate at Provida Fitness, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in this program. 4. In consideration of being permitted to participate at Provida Fitness, I knowingly, voluntarily, and expressively waive any claim I may have against Sergio Seminario, Provida Fitness, or any other fitness instructor associated with Provida Fitness for injury or damages that I may sustain as result of participating in the program. 5. I, my heirs or legal representatives forever release, waive, discharge, and covenant not to sue Sergio Seminario, Provida Fitness, or any associate/instructor or staff member of Vida Fitness for any injury or death caused by the negligence or other acts. I have read the above agreement of release and waiver or liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above. 18+ * I am 18 years or older How did you hear about us? Facebook Instagram Google Friends & Family Thank you!