Consent, Release and Waiver of Liability Agreement  

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Voluntary Exercise Sessions: 

By signing this agreement I hereby acknowledge that my participation in the voluntary dancing/ exercise sessions/recreational activity beginning today, and continuing thereafter on various dates Monday – Sunday during various hours, is completely voluntary and is not required as a part of my partnership or employment with InTouch Outreach Resource Center (“ITOR”).  

I am fully aware that any and all exercise and physical activity on my part, or my participation therein, may be dangerous and involve risks and dangers of my being seriously injured, paralyzed or killed. In addition to physical injury, I am fully aware that exercising and/or any physical activity or related activities involves risks and dangers of financial injury and loss. I am further aware that such risks of physical and financial injury exist with respect to any such exercise activities and/or any physical activity. Despite such risks of injury involved in any such exercise and/or physical activities, I freely and voluntarily choose to be involved, assuming all risks of injury, paralysis or death.  

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Because I understand and assume all risks involved in participation in such exercise and/or other physical activities, I hereby waive any and all legal or other claims that I, my assignees, heirs, distributees, guardians, legal representatives and/or successors may have, if any, against ITOR, its employees or assignees and any and all people associated with  any and all exercise sessions, for any and all injuries that I may incur as a result of my participation in such exercise and/or related physical activities. Such risk of injury that I am knowingly and voluntarily assuming, and for which I am releasing liability, may result from negligence of a Released Party; my own negligence, or the negligence of any third party while I am participating in the exercise activity.  

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I have not been ordered by ITOR to participate in this exercise session /recreational activity, nor have I been paid wages or travel expenses while participating in this exercise session/recreational activity. To the extent any disability or death is proximately caused by this voluntary recreational activity, I understand that worker's compensation benefits or compensation will not be available, and I waive any rights I may have, if any, to these benefits.  

I acknowledge that this Release and Waiver of Liability is being relied upon by InTouch Outreach Resource Center in allowing me to use any of ITOR’s facilities for this voluntary exercise session described herein. 

 

Photo and Video Content: 

I further consent for photographs and/or video images to be taken of me by In Touch Outreach Resource Center (“ITOR”) or a representative. I understand the images may be used for purposes of teaching or training or for marketing purposes (website, print, digital or social media). By consenting to photographs and/or video images I understand I will not be compensated from any party. Although photographs and/or video images will be used without identifying information such as name, I understand it is possible someone may recognize me. I further acknowledge that my participation is voluntary and agree that use of any photographs and/or video images confers no rights of ownership or royalties whatsoever.  

 

I authorize the use of photographs and/or video images.  

 

I hereby release ITOR, its employees, and any third parties involved in the creation of or publication of educational or marketing materials, from liability for any claims by me or any third party in connection with my participation.  

 

By signing this form, I confirm understanding of this consent. If I wish to withdraw my consent in the future, I may do so via written request submitted to: 

 InTouch Outreach Resource Center 

 4084 Pendleton Way #154 

Indianapolis, Indiana 46226 

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