MOVE In-Person Program Additional Individual Participation Form

MOVE by GoodLife Kids In Person Program Caregiver Participation Form

Any caregivers who will be joining the workouts with MOVE Participant are required to complete the following form. Questions? Reach out at move@goodlifekids.com.

Please complete this form in one sitting as the form will not save until you select “SUBMIT” on the last page. Google Chrome is the recommended web browser.
The following must be electronically signed by anyone participating in MOVE by GoodLife Kids Program
– Liability and photo/video release waiver
– Physical Activity Readiness Questions  

You will receive a copy of the completed waivers immediately by email. If you do not receive it, please check your junk mail folder.

MOVE Participants Full Name(Required)

This helps connect your form to the correct participant.

First Last

Date(Required)

Your Full Name(Required)

First Last

Relationship to the MOVE Participant(Required)

Your Date of Birth(Required)

Caregivers must be over the age of 18 years old to attend as a support for the MOVE Participant.

Your Email Address(Required)

Physical Activity and Readiness Questionnaire

Have you or the individual you are signing for had (within the past 12 months) a bone, joint, or soft tissue (muscle, ligament, or tendon) problem or other medical conditions that could be made worse by becoming more physically active?(Required)

Please answer NO if they had a problem in the past, but it does not limit their current ability to be physically active. Includes injuries or conditions related to heart, blood pressure, respiratory disease, back problems, or another condition.

Yes

Has your doctor ever said that they should only do medically supervised physical activity?(Required)

Yes

Is there anything else we should know about your readiness to start Physical Activity?(Required)

If you have answered yes to any of the above questions please consult a medical professional prior to beginning exercise.

CAREGIVER DECLARATION

[If you are less than the legal age required for consent or require the assistance of a care provider, your parent, guardian or care provider must also sign this form.]

I, the undersigned, have read, understood to my full satisfaction and completed this questionnaire. I acknowledge that this physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if my condition changes. I also acknowledge that GoodLife Kids Foundation may retain a copy of this form for its records. In these instances, it will maintain the confidentiality of the same, complying with applicable law.

Your Full Name(Required)

Waiver

MOVE by GoodLife Kids – WAIVER AND VIDEO/PHOTO RELEASE
(hereinafter referred to as the “Release Agreement”)

BY SIGNING THIS DOCUMENT, YOU WILL WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE OR CLAIM COMPENSATION FOLLOWING AN ACCIDENT
PLEASE READ CAREFULLY!

By my or my child’s participation (collectively referred to as “participants”) in a MOVE by GoodLife Kids Program (“the Program”) hosted online via Zoom, I hereby acknowledge and agree with the following:

That fitness activities, exercise and participation in the Program may expose participants to risks and hazards, some of which are inherent in the very nature of the fitness activities and exercise itself, others which result from human error and negligence and, as a result of such risk I, acknowledge that as participants, I or my child may suffer serious personal injury (even death). I understand that the GoodLife Kids Foundation (“the Foundation”), GoodLife Fitness Centres Inc. (“GoodLife”), the organizers of the Program and their respective officers, directors, employees, independent contractors, agents, affiliated clubs, sponsors, and volunteers (collectively the “Releasees”) do not assume any responsibility whatsoever for my safety during my participation in the Program. I nevertheless freely and voluntarily assume all the aforesaid risks and hazards, and the possibility of personal injury, death, property damage or loss, resulting therefrom and, I assume all risks of injury to myself or others including any illness or medical condition and any NEGLIGENCE ON THE PART OF THE RELEASEES, INCLUDING THE FAILURE ON THE PART OF THE RELEASEES TO TAKE REASONABLE STEPS TO SAFEGUARD OR PROTECT ME FROM THE RISKS, DANGERS AND HAZARDS OF PARTICIPATING IN THE PROGRAM.

I agree on my child’s behalf, my own behalf, and on behalf of my personal representatives, heirs, estate trustees or assigns to: (a) waive any and all claims that I have or may have in the future against the Releasees and I release, indemnify and discharge Releasees from any and all claims or causes of action (known or unknown) which may arise out of participation in the Program, DUE TO ANY CAUSE WHATSOEVER, INCLUDING NEGLIGENCE, BREACH OF CONTRACT, OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE ON THE PART OF THE RELEASEES, AND FURTHER INCLUDING THE FAILURE ON THE PART OF THE RELEASEES TO TAKE REASONABLE STEPS TO SAFEGUARD OR PROTECT ME FROM THE RISKS, DANGERS AND HAZARDS OF PARTICIPATING IN THE PROGRAM; and (b) to indemnify and save the Releasees harmless from any and all claims or causes of action (known or unknown) brought against the Releasees by any party arising out of mine or my child’s actions, including my negligence, while participating in the Program.

I acknowledge that I may submit photographs or videos of my or my child’s participation in the Program, and that the Foundation may take photographs or videos during the Program that my image, likeness, voice and/or performance may be captured in such photographs and videos. I hereby unconditionally and irrevocably consent, authorize and grant to the Foundation, its successors, assigns and licensees, all necessary authority, right and license to use any photographs or videos (collectively “Photographs”) containing mine or my child’s image, throughout the world without limitations or restrictions and in their sole discretion, including without limitation: reproduction in all media, publication, display, exhibition for promotion, advertising, trade, art, or illustration. I confirm that the Foundation does and will forever own and retain all right, title and interest throughout the world in the Photographs, subject only to any assignment or license it may grant in its sole discretion. I hereby irrevocably and unconditionally assign to the Foundation and its licensees, successors and assigns all right, title and interest (including privacy, personality, moral and publicity rights) I have or may acquire in my image, likeness, voice and performance as contained in the Photographs and waive in favour of the Foundation and its licensees, successors and assigns all non-transferable rights and interests in the Photographs.

I HEREBY RELEASE THE RELEASEES from any and all claims which I may now or in the future have relating to the ownership, reproduction, display, distribution or other use of the Photographs and will hold them harmless in relation to complaints, actions, causes of action, liabilities, damages, losses, legal fees, costs and expenses of any nature and kind whatsoever incurred by any of them by reason of any claim relating to any damage whatsoever in respect of any act or omission in respect of the Photographs or any exploitation of the Photographs or this Agreement. I also acknowledge that all Programs offered by a MOVE Coach online may be recorded and saved for quality and training purposes. I understand that recordings will be stored securely by the Foundation for a minimum period of one (1) year. I hereby waive my rights to privacy and compensation, which I may have in connection with such use of my or my child’s name and likeness, including rights to any written copy that may be created in connection with video production, editing and promotion therewith.

If I am the parent or guardian of a minor participant (“the Minor”), I am hereby providing my express consent to the Foundation and GoodLife to allow the Minor to participate in the Program. By checking the box below, I am agreeing to the terms and conditions of this Release Agreement on my own behalf and/or on behalf of the Minor, as their parent or guardian. I acknowledge and agree that my heirs, executors, administrators and assigns will also be bound by this Release Agreement.

I have read the above MOVE by GoodLife Kids Waiver- Video and Photo Release.

Your Full Name(Required)
Please enter your full name to confirm your electric signature.