In light of the COVID-19 situation, Tampa Movement Lab is implementing certain precautionary measures to ensure the health, safety and well-being of our employees and clients. We request that you complete the below form, in advance of your planned visit.
The following countries are the subject of the first two questions below:
China, Macau, Italy, South Korea, Hong Kong, Japan and Iran.
Have you traveled to, through or from one of the above countries in the last 14 days?
To the best of your knowledge, have you been in contact with anyone who has traveled to, through or from one of the above countries in the last 14 days?
To the best of your knowledge, have you been in close contact with anyone who is being evaluated or has been diagnosed with COVID-19?
Are you experiencing or have you experienced in the last 14 days any flu-like symptoms (fever, cough, shortness of breath)?
If you answered “yes” to any of the above questions, you will need to attend class or PT session virtually during the time that the city requires special action due to COVID-19.
If you answered “no” to all of the above questions, please turn the completed form on your first visit to Tampa Movement Lab to the front desk attendant or coach at the gym. If you begin to experience flu-like symptoms after you submit this form, please arrange to attend class or PT session virtually or on a later date.
Tampa Movement Lab Personal Training & Group Fitness
Release, Waiver of Liability and Covenant Not to Sue
In consideration of my acceptance into and participation in a program of strength, flexibility and cardiovascular training conducted by Tampa Movement Lab and for other good and valuable consideration, and having knowledge of the dangers and risks in this program as further described below, I hereby release, hold harmless and discharge forever Tampa Movement Lab (Michelle Richards LLC) and CrossFit Inc., its fitness centers and its officers, employees, instructors, operators, and agents from any and all present and future claims, liability, and demands for property damage, personal injury, illness, wrongful death or other damage or costs or expenses arising as a result of, or in connection with, my participation in the program. I agree not to sue Tampa Movement Lab (Michelle Richards LLC) and CrossFit Inc. or others stated above in connection with any such injury or damage as stated above. I hereby voluntarily waive any and all claims, present and future that may be made by me, my family, estate, heirs, assigns or others acting on my behalf and assume all risks arising from the program. (Please Initial: _________)
Further, I am aware that strength, flexibility and cardiovascular exercise, including the use of equipment are a potentially hazardous activity. I am aware and understand that fitness activities involve certain risks, including but not limited to, death, serious neck and spinal injuries resulting in complete or partial paralysis, heart attack, serious disability, and serious injury to all bones, joints and muscles and that I am voluntarily participating in these activities and using equipment and machines with full knowledge, understanding and appreciation of the dangers involved. I hereby agree to accept any and all inherent risks of injury or death.
(Please Initial: _________)
I do hereby further declare myself to be physically fit and suffering from no condition, impairment, disease, infirmity or other illness that would prevent my participation or use of equipment or machines. I acknowledge that I have either had a physical examination and have been given permission by my physician to participate, or I have decided to participate in the exercise activities, programs and use of equipment without the approval of my physician in said activities, programs and use of equipment.
(Please Initial: _________)
I further agree to indemnify and hold harmless Tampa Movement Lab (Michelle Richards LLC) and CrossFit Inc. and others listed for any and all claims based on my acts or omissions, or the acts or omissions of others, arising as a result of my participation in or receiving instruction in strength, flexibility and cardiovascular activities or any activities incidental thereto, wherever, whenever, or however the same may occur.
(Please Initial: __________)
I understand that this waiver is intended to be as broad and inclusive as permitted by Washington Law and Florida Law which shall be the applicable law in any legal proceeding arising from a claim under the program and agree that if any portion is held invalid, the remainder or the waiver will continue in full legal force and effect. I further agree that the venue for any legal proceedings shall be in the State of Florida.
(Please Initial: ____________)
I affirm that I am of legal age and am freely signing this agreement relying on my own judgment and knowledge. I have carefully read this document and understand and acknowledge that by signing this document, I am giving up all legal rights and remedies, which may be available to me for the acts or omissions of Tampa Movement Lab (Michelle Richards LLC) and CrossFit Inc. and others listed above.
Signature: ________________________________________________________________ Date: __________________________
Parent/Guardian Signature (if Client is under 18): ______________________________________ Date: __________________________
Staff Signature: __________________________________________________________________ Date: __________________________