Participant Information

Name: ______________________________________ DOB: ____________________

Phone: ______________________ Email: ____________________________________

Emergency Contact: _________________________ Phone: ___________________

1. Covered Services

This waiver applies to all services provided by Empowered Fitness & Recovery LLC (EFR), including but not limited to:  personal training, group training, boxing, yoga, Zumba, Body Pump, fitness classes, infrared sauna, red light therapy, cold plunge, circulation therapy, physical therapy, acupuncture, Reiki, and any other related services or wellness modalities offered by EFR.

2. Acknowledgment of Risk

I understand that participation in EFR services involves inherent risks, including but not limited to: physical exertion, muscle strains or sprains, dehydration, burns or skin irritation, allergic reactions, cardiovascular events, and emotional stress. I acknowledge that injuries may result from equipment misuse, improper form, slippery surfaces, or underlying medical conditions. I accept full responsibility for these and any other risks, whether known or unknown, voluntary or involuntary.

3. Medical Clearance & Personal Responsibility

I certify that I am in suitable physical and mental condition to participate in EFR’s services. I understand that it is my responsibility to consult with a licensed healthcare provider before beginning any fitness, recovery, or wellness program, especially if I have a pre-existing condition or am pregnant. I understand EFR does not provide medical advice, nor is it responsible for determining my eligibility to participate in any service.

4. Voluntary Participation & Release of Liability

I am voluntarily participating in EFR’s services at my own risk. In consideration of my participation, I hereby release and hold harmless EFR, its owners, employees, agents, contractors, affiliates, and volunteers from any liability, claims, or demands arising out of any injury, illness, damage, or loss I may experience, except in cases of gross negligence or intentional misconduct.

5. Emergency Medical Consent

In the event of a medical emergency, I authorize EFR staff to seek emergency medical treatment on my behalf. I understand I am financially responsible for any associated costs.

6. Injury Reporting Policy

I agree to report any injury, discomfort, or incident immediately and before leaving the premises. Failure to do so will result in EFR not being held responsible. This clause is binding and non-negotiable.

7. Results Disclaimer

I understand that individual results from fitness, recovery, or wellness services are not typical or guaranteed. Outcomes vary based on personal effort, consistency, and other factors beyond EFR’s control.

8. Code of Conduct

I agree to follow instructions given by EFR staff, conduct myself respectfully, and refrain from behavior that disrupts sessions or compromises the safety of others. EFR reserves the right to terminate services for violation of this code.

9. Media Release

I grant EFR permission to use any photos, videos, or testimonials for promotional purposes, unless I opt out in writing.

10. Severability Clause

If any part of this agreement is found to be unenforceable, the remaining terms shall remain valid and in full effect.

CODE OF CONDUCT

At Empowered Fitness & Recovery, we are committed to creating a safe, respectful, and high-vibe environment for everyone who walks through our doors. By entering this space, you agree to uphold the following standards:

1. Respect Is Mandatory

Treat all clients, guests, and staff with courtesy and professionalism. Harassment of any kind—sexual or otherwise—will not be tolerated. Period.

2. Zero Tolerance for Disruptive Behavior

Fighting, intimidation, threats, or any behavior that creates an unsafe or hostile environment will result in immediate removal and a permanent ban from the premises, regardless of membership status.

3. Respect the Space and Equipment

Use all equipment properly, with care and intention. Deliberate mistreatment, reckless use, or damage to facility property—including restrooms—will not be tolerated. Keep bathrooms clean and presentable out of respect for your fellow clients.

4. No Stealing, No Excuses

Theft of any kind—personal items, equipment, products, or services—is grounds for permanent removal from the facility and may result in legal action. You steal, you’re out. Done.

5. Positive Vibes Only

We’re building a culture of growth, grit, and good energy. Any behavior that detracts from that—disrespect, negativity, or rule-breaking—jeopardizes your access to this space.

By participating in any activity or class at Empowered Fitness & Recovery, you agree to this Code of Conduct. Violations will result in immediate removal from the facility and a permanent ban.

We’re not just a club. We’re a community. And we protect our own.

Acknowledgment & Agreement

I acknowledge that I have read, understood, and voluntarily agree to this General Waiver & Release of Liability. I am at least 18 years old. If under 18, this form must be signed by a parent or legal guardian.

Participant Name (Print): _______________________________________________

Signature: _______________________________________ Date: ________________

Guardian Name (if applicable): _________________________________________

Guardian Signature: _____________________________ Date: ________________

For electronic signing, typing your full name will serve as your official digital signature.

Type Signature Here: 

__________________________________________________________________

CONTACT US

Empowered Fitness & Recovery LLC

3350 W. Salt Creek Lane

Suite 109

Arlington Heights, IL 60005

Email: [email protected]

Phone: (224) 379-0416