I hereby certify that I am the adult parent or guardian of _____________, a minor child under the age of eighteen years, and I consent to his/her participation in recreational activities at Gym Number Five.

I understand the risk of injury from CLUB activities and using any CLUB equipment is significant, including the potential for permanent paralysis and death, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown. I acknowledge that this is an UNSUPERVISED FITNESS CENTER and I assume all risks associated with using exercise equipment and other products and machines and exercising alone without the aid and presence of CLUB staff on the premises. In addition, I acknowledge that club activities may include outdoor activities which may present additional risks, such as slippery surfaces, uneven surfaces, loose rock or gravel, and unseen roots and other items. I HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS Gym Number Five LLC and its affiliates, AND THE OWNERS OF ALL CLUBS WITHIN THE GYM NUMBER FIVE SYSTEM, as well as all sponsors and advertisers, and all owners and lessors of the premises of such clubs, and their respective officers, affiliates, agents and employees WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, LOSS OR DAMAGE to person or property that may arise out of or in connection with use of any of the equipment products and machines or the facilities of the CLUB, or any indoor or outdoor exercise program offered at or by the CLUB, or of any other Gym Number Five club, or any incident that occurs while using such facilities, or otherwise related to (1) said minor child’s participation/membership.

I expressly agree that this release is intended to be as broad and inclusive as permitted by applicable law and if a portion of this release is held invalid, the balance shall remain in full force and effect. This release shall apply to my heirs, assigns, personal representatives and any other next of kin. I understand that the CLUB is relying on this release in agreeing to enter into this Agreement.