Required Liability Form
Health & Fitness Liability Waiver / Informed Consent Form
Assumption of Risk
I, ________________, have enrolled in the personalized health and fitness programs
offered by Living Patterns, LLC via Keridon Davis McMahon. I recognize that the
programs may involve strenuous physical activity including muscle strength and
endurance training, cardiovascular conditioning and training, and other fitness activities.
I hereby affirm that I am in good physical condition and do not suffer from any known
disability or condition which would prevent or limit my participation in this exercise
program. I recognize that an examination by a physician should be obtained by all
participants prior to involvement in any fitness or exercise program, and, if I have
chosen not to obtain a physician’s permission prior to beginning a program with Living
Patterns, I do so at my own risk. I acknowledge that any exercise program, including
this one, is a potentially hazardous activity and that my enrollment and subsequent
participation is purely voluntary.
Release and Waiver
I, on behalf of myself, my heirs, administrators, successors and assigns, hereby forever
release, discharge and hold harmless Living Patterns, LLC and its officers, agents, and
employees, and Keridon Davis McMahon individually (collectively, “Living Patterns”),
from any and all claims, demands, liabilities, expenses, rights of action or causes of
action, present or future, arising out of or connected with my participation in this or any
program offered by Living Patterns, including any injuries resulting therefrom, including
heart attacks, muscle strains, muscle pulls or tears, injuries to knees, injuries to back,
injuries to feet, or any other personal, bodily or mental illness or injury that I may incur,
including death, and economic loss. This waiver and release of liability includes, without
limitation, injuries which may occur as a result of (i) my participation in any Living
Patterns program; and (ii) negligence, fault or carelessness of Living Patterns.
I further agree to hold harmless and indemnify Living Patterns from any liability, claims,
court actions, or causes of action for any damage or injury I might suffer or cause to the
person or property of other persons while participating in the said activities.
I make this Release of Liability, Hold Harmless Waiver Agreement voluntarily and
realizing the consequences of said waiver and such release. Further, I certify that I am
over eighteen (18) years of age and I am not acting under any duress, fraud, undue
influence or type of mental disability.
I ACKNOWLEDGE THAT I HAVE THOROUGHLY READ THIS AGREEMENT IN
ITS ENTIRETY AND FULLY UNDERSTAND THAT IT IS A RELEASE OF
LIABILITY. BY SIGNING BELOW, I AM WAIVING ANY RIGHT I OR MY
SUCCESSORS MIGHT HAVE TO BRING A LEGAL ACTION OR ASSERT A
CLAIM AGAINST LIVING PATTERNS, LLC OR KERIDON DAVIS MCMAHON