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Name *

First Name

Last Name

Location *

Select which location you will be training at.

Nassau Fitness

Wellspring Fitness

Elevate Fitness

Totem Health & Fitness

Club Level Fitness

Xhale Fitness

Englewood Field Club

Assumption of Risk& Waiver of Liability *

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread primarily from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. EXERCISE WITH A PURPOSE LLC and IVY LEAGUE HEALTH AND FITNESS INC. (Herein referred to as EXERCISE WITH A PURPOSE) has put in place preventative measures to reduce the spread of COVID-19; however, EXERCISE WITH A PURPOSE cannot guarantee that you will not become infected with COVID-19. Please read the following statement and acknowledge and accept the same by signing below: By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by visiting or participating in activities at EXERCISE WITH A PURPOSE, and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 while at EXERCISE WITH A PURPOSE may result from the actions, omissions, or negligence of myself and others, including, but not limited to, EXERCISE WITH A PURPOSEemployees, owners, volunteers, members, guests, visitors and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself (including but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expenses, of any kind, that I may experience or incur in connection with my presence at EXERCISE WITH A PURPOSE or participation in any EXERCISE WITH A PURPOSE programs, activities or events (“Claims”). I hereby release, covenant not to sue, discharge, and hold harmless EXERCISE WITH A PURPOSE, its employees, owners, agents and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of EXERCISE WITH A PURPOSE, its employees, owners, agents, and representatives, whether a COVID-19 infection occurs before, during or after visitation, play or participation in any program or activity at EXERCISE WITH A PURPOSE.

By checking this box, I hereby confirm that I have read, consent and agree to Exercise With a Purposes' COVID-19 Health and Safety Waiver * Release form

Name *

First Name

Last Name

Cell Phone *

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Home Phone

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Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth *

MM

DD

YYYY

Name *

First Name

Last Name

Cell Phone *

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Home Phone

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Medical History *

Do you now have, have you recently experienced, or have you ever had: (check all that apply)

Heart attack, coronary bypass, or stroke

Extra, skipped, or rapid heartbeats/palpitations

Asthma, respiratory problems, pulmonary disease

Thyroid condition

Arthritis or orthopedic problems

Bone or joint disorders or injuries

Ulcer

Arteriosclerosis

Increased anxiety

Depression

Fatigue or lack of energy

Dizziness or shortness of breath

High or low blood cholesterol

High or low blood pressure

Diabetes

Epilepsy

Cancer

Kidney disease

Neuromuscular disease

Bulimia or Anorexia

Weight loss or gain

Trouble sleeping

None of the above

Are you aware, through your own experiences or a doctor’s advice, of any physical reason against your exercising without medical supervision? *

Yes

No

Are you over the age of 65 and not accustomed to rigorous exercise? *

Yes

No

Are you currently or have you been pregnant within the last six months? *

Yes

No

Assumption of Risk, Parental Consent, & Indemnity Agreement *

In consideration of my being permitted to participate in any way in activities (“Activity”) sponsored by Exercise With a Purpose ("EWAP"), its principal, agents and/or employees, I acknowledge my understanding of and my agreement with the following: 1. I understand the nature of EWAP activities and believe I am qualified to participate in such Activity. I further acknowledge that I am aware the activity will be conducted in facilities open to the public during the Activity. I further agree and warrant that if at any time I believe conditions to be unsafe, I will immediately discontinue further participation in the Activity. 2. I fully understand that: (a) EWAP Activities involve risks and dangers of serious bodily injury, including permanent disability, paralysis and death (“Risks”); (b) these Risks and dangers may be caused by my own actions, or inaction’s, the actions or inaction’s of others participating in the Activity, the condition in which the Activity takes place, or the negligence of the “Releasees” named below; (c) there may be other risks and social and economic losses either not known to me or not readily foreseeable at this time; and I fully accept and assume all such risks and all responsibility for losses, costs, and damages incurred as a result of my participation in the Activity. 3. I hereby release, discharge, covenant not to sue, and agree to indemnify and save and hold harmless EWAP, their respective administrators, directors, agents, officers, volunteers, and employees, other participants, any sponsors, advertisers, and if applicable, owners and lessors of premises on which the Activity takes place (each considered one of the “Releasees” herein) from all liability, claims, demands, losses, or damages on my account caused or alleged to be caused in whole or in part by the negligence of the “Releasees” or otherwise, including negligent rescue operations and further agree that if, despite this release, I, or anyone on my behalf makes a claim against any of the Releasees named above, I will indemnify, save and hold harmless each of the Releasees from any litigation expenses, attorney fees, loss liability, damage or cost any may incur as the result of any such claim. I have read the agreement, fully understand its terms, understand that I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid that the balance, notwithstanding, shall continue in full force and effect.

By checking this box, I hereby confirm that I have read, consent and agree to Exercise With a Purposes' Physical Waiver & Release Form

Assumption of Risk, Parental Consent, & Indemnity Agreement *

In consideration of my being permitted to participate in any way inactivities (“Activity”)sponsored by Exercise With a Purpose (“EWAP”), its principal, agents and/or employees, I acknowledge my understanding of and my agreement with the following: Exercise With a Purposes’approach to human performance enhancement involves coaching in the areas of physical exercise, motivation, mindfulness, goal setting, and spiritual empowerment. The coaching services provided by EWAP, its principal, agents and/or employees do not constitute therapy, counseling or professional psychological services as defined by the New Jersey State Board of Psychological Examiners. The coaching services provided by EWAP do not constitute medical care or treatment, nor the diagnosis or treatment of physical or mental illness or psychological disorders. I understand that EWAP recommends a full psychiatric evaluation and/or professional psychological services for persons actively engaged in substance abuse, self-harm or otherwise experiencing psychological issues.

By checking this box, I hereby confirm that I have read, consent and agree to Exercise With a Purposes' Behavioral Waiver * Release form

Assumption of Risk& Waiver of Liability *

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread primarily from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. EXERCISE WITH A PURPOSE LLC and IVY LEAGUE HEALTH AND FITNESS INC. (Herein referred to as EXERCISE WITH A PURPOSE) has put in place preventative measures to reduce the spread of COVID-19; however, EXERCISE WITH A PURPOSE cannot guarantee that you will not become infected with COVID-19. Please read the following statement and acknowledge and accept the same by signing below: By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by visiting or participating in activities at EXERCISE WITH A PURPOSE, and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 while at EXERCISE WITH A PURPOSE may result from the actions, omissions, or negligence of myself and others, including, but not limited to, EXERCISE WITH A PURPOSEemployees, owners, volunteers, members, guests, visitors and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself (including but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expenses, of any kind, that I may experience or incur in connection with my presence at EXERCISE WITH A PURPOSE or participation in any EXERCISE WITH A PURPOSE programs, activities or events (“Claims”). I hereby release, covenant not to sue, discharge, and hold harmless EXERCISE WITH A PURPOSE, its employees, owners, agents and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of EXERCISE WITH A PURPOSE, its employees, owners, agents, and representatives, whether a COVID-19 infection occurs before, during or after visitation, play or participation in any program or activity at EXERCISE WITH A PURPOSE.

By checking this box, I hereby confirm that I have read, consent and agree to Exercise With a Purposes' Health and Safety Waiver * Release form

Name *

First Name

Last Name

Cell Phone *

(###)

###

####

Home Phone

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth *

MM

DD

YYYY

Name *

First Name

Last Name

Cell Phone *

(###)

###

####

Home Phone

(###)

###

####

Name

First Name

Last Name

Cell Phone

(###)

###

####

Home Phone

(###)

###

####

Medical History *

Do you now have, have you recently experienced, or have you ever had: (check all that apply)

Heart attack, coronary bypass, or stroke

Extra, skipped, or rapid heartbeats/palpitations

Asthma, respiratory problems, pulmonary disease

Thyroid condition

Arthritis or orthopedic problems

Bone or joint disorders or injuries

Ulcer

Arteriosclerosis

Increased anxiety

Depression

Fatigue or lack of energy

Dizziness or shortness of breath

High or low blood cholesterol

High or low blood pressure

Diabetes

Epilepsy

Cancer

Kidney disease

Neuromuscular disease

Bulimia or Anorexia

Weight loss or gain

Trouble sleeping

None of the above

Are you aware, through your own experiences or a doctor's advice, of any physical reason against the aforementioned minor exercising without medical supervision? *

Yes

No

Is the aforementioned minor currently or previously pregnant within the last six months *

Yes

No

Assumption of Risk, Parental Consent, & Indemnity Agreement *

In consideration of my minor child being permitted to participate in any way in activities (“Activity”) sponsored by EWAP (“EWAP”), its principal, agents and/or employees, I acknowledge my understanding of and my agreement with the following: 1. I understand the nature of EWAP activities and the Minor’s experience and capabilities and believe the Minor to be qualified to participate in such Activity. I further acknowledge that I and the Minor are aware the activity will be conducted in facilities open to the public during the Activity. I further agree and warrant and will instruct the Minor that if at any time the Minor believes conditions to be unsafe, he/she will immediately discontinue further participation in the Activity. 2. I fully understand that: (a) EWAP Activities involve risks and dangers of serious bodily injury, including permanent disability, paralysis and death (“Risks”); (b) these Risks and dangers may be caused by the Minor’s own actions, or inaction’s, the actions or inaction’s of others participating in the Activity, the condition in which the Activity takes place, or the negligence of the “Releasees” named below; (c) there may be other risks and social and economic losses either not known to me or not readily foreseeable at this time; and I fully accept and assume all such risks and all responsibility for losses, costs, and damages incurred as a result of the Minor’s participation in the Activity. 3. I hereby release, discharge, covenant not to sue, and agree to indemnify and save and hold harmless EWAP, their respective administrators, directors, agents, officers, volunteers, and employees, other participants, any sponsors, advertisers, and if applicable, owners and lessors of premises on which the Activity takes place (each considered one of the“Releasees” herein) from all liability, claims, demands, losses, or damages on the minor’s account caused or alleged to be caused in whole or in part by the negligence of the “Releasees” or otherwise, including negligent rescue operations and further agree that if, despite this release, I, the minor, or anyone on the Minor’s behalf makes a claim against any of the Releasees named above, I will indemnify, save and hold harmless each of the Releasees from any litigation expenses, attorney fees, loss liability, damage or cost any may incur as the result of any such claim. I have read the agreement, fully understand its terms, understand that I and the Minor have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid that the balance, notwithstanding, shall continue in full force and effect.

By checking this box, I, the legal guardian, hereby confirm that I have read, consent and agree to Exercise With a Purposes's Physical Waiver & Release Form on behalf of the aforementioned minor

Assumption of Risk, Parental Consent, & Indemnity Agreement *

In consideration of my minor child being permitted to participate in any way inactivities (“Activity”) sponsored by Exercise With a Purpose (“EWAP”), its principal, agents and/or employees, I acknowledge my understanding of and my agreement with the following: EWAP's approach to human performance enhancement involves coaching in the areas of physical exercise, motivation, mindfulness, goal setting, and spiritual empowerment. The coaching services provided by EWAP, its principal, agents and/or employees do not constitute therapy, counseling or professional psychological services as defined by the New Jersey State Board of Psychological Examiners. The coaching services provided by EWAP do not constitute medical care or treatment, nor the diagnosis or treatment of physical or mental illness or psychological disorders. I understand that EWAP recommends a full psychiatric evaluation and/or professional psychological services for persons actively engaged in substance abuse, self harm or otherwise experiencing psychological issues. EWAP will report the use of any illegal substances as well as any explicitly harmful behaviors to the parent or legal guardian of any minor.

By checking this box, I, the legal guardian, hereby confirm that I have read, consent and agree to Exercise With a Purpose's Behavioural Waiver & Release Form on behalf of the aforementioned minor

Assumption of Risk & Waiver of Liability *

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread primarily from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. EXERCISE WITH A PURPOSE LLC AND IVY LEAGUE HEALTH AND FITNESS INC. (Herein referred to as CLUB LEVEL FITNESS) has put in place preventative measures to reduce the spread of COVID-19; however, EXERCISE WITH A PURPOSE cannot guarantee that you and/or your child(ren) will not become infected with COVID-19. Please read the following statement and acknowledge and accept the same by signing below: By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by visiting or participating in activities at EXERCISE WITH A PURPOSES and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 while at EXERCISE WITH A PURPOSE may result from the actions, omissions, or negligence of myself and others, including, but not limited to, EXERCISE WITH A PURPOSE employees, owners, volunteers, members, guests, visitors and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expenses, of any kind, that I or my child(ren) may experience or incur in connection with my or my child(ren)’s presence at EXERCISE WITH A PURPOSE or participation in any EXERCISE WITH A PURPOSE programs, activities or events (“Claims”). On my behalf, and on behalf of my child(ren), I hereby release, covenant not to sue, discharge, and hold harmless EXERCISE WITH A PURPOSE, its employees, owners, agents and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of EXERCISE WITH A PURPOSE, its employees, owners, agents, and representatives, whether a COVID-19 infection occurs before, during or after visitation, play or participation in any program or activity at EXERCISE WITH A PURPOSE.

By checking this box, I, the legal guardian, hereby confirm that I have read, consent and agree to Exercise With a Purpose's Health & Safety Waiver on behalf of the aforementioned minor.