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MADISON SENIOR CENTER WAIVER

  1. The Madison Senior Center recommends that participants complete a physical examination and advise their physician of their participation in the Exercise Class, so as to identify any restrictions or limitations to exercise. I have enrolled in the Exercise Class offered by the Madison Senior Center. I recognize that participation in the Exercise Class include, but is not limited to, the risk of death or serious injury, and stress-related injuries resulting from: the risks/hazards of physical exertion, my conduct and the conduct of other participants, and the use of equipment. In consideration of my participation in the Exercise Class, I hereby release and discharge the Madison Senior Center, its agents, officers, volunteers, participants, employees and all other persons acting in any capacity on its behalf, along with the Borough of Madison, its affiliated departments, and its officers, trustees, agents, employees, successors and assigns, and their heirs, personal representatives and assigns, (herein collectively referred to as “Madison Senior Center”), on behalf of myself, my children, my heirs, my assigns, personal representatives and all other persons acting on my behalf, in any capacity, from any and all liability for claims, suits, personal injury, death, property damage or loss, or any other claim or loss resulting from or arising out of my participation in the Exercise Class. I certify that I will abide by all safety rules and directions of the instructors. I further acknowledge that failure to abide by all safety rules and directions of the instructors may result in my being disqualified from participating in the Exercise Class. IN SIGNING THIS CONSENT FORM, I AFFIRM THAT I HAVE READ THIS FORM IN ITS ENTIRETY. I UNDERSTAND THE NATURE OF THE EXERCISE CLASS. I ALSO AFFIRM THAT MY QUESTIONS REGARDING THE EXERCISE PROGRAM HAVE BEEN ANSWERED TO MY SATISFACTION.

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