WAIVER AND RELEASE OF LIABILITY AGREEMENT

ASSUMPTION OF RISK OF INJURY, DAMAGE, OR DEATH FOR FITNESS USE

(Turn into Human Resources)

I, ________________________, (print name) voluntarily request to use the City of De Pere (“City”) fitness equipment and/or participate

in City sponsored fitness class(es) (collectively referred to as “fitness use”) in the lower level police department training room located

in City Hall (335 S. Broadway St.) and/or in the basement of the Municipal Services Center (925 S. Sixth St.) (“ facilities”).

I understand that my fitness use of the facilities is voluntary and I do so at my own risk. I understand that use of the facilities is restricted

to only those off work/duty times designated by the City as open for use and that any injury or loss suffered shall not be covered under

I understand and am aware that strength, flexibility and aerobic exercise, are potentially hazardous and dangerous activities. I understand

that individual workouts with or without supervision can be dangerous. I also understand that fitness activities involve a risk of injury

and even death and that I am voluntarily assuming any risk in participating in these activities, engaging in fitness use, or accessing and

using the facilities with knowledge of the dangers involved. I hereby agree to and expressly assume and accept any and all risk of any

injury, damage, or death.

I hereby declare myself to be physically sound and suffering from no condition, impairment, disease, infirmity or other illness that would

prevent my participation or use of the facilities or my fitness use. I hereby acknowledge that I have either had a physical examination

and been given my physician’s permission to engage in fitness use and utilize the facilities for fitness purposes, or that I have decided

to assume any risk and participate without the approval of my physician and do hereby assume all responsibility for my fitness use and

In consideration of being allowed to utilize the facilities and participate in fitness use, I hereby agree, on behalf of myself, my heirs,

executors, representatives, agents and assigns to waive, release, absolve, defend, indemnify and hold harmless and forever discharge the

City of De Pere, its officials, officers, employees, agents and all others from any and all responsibility or liability for any injuries,

including death, damages, loss, from and against any and all manner of actions, claims, causes of action, suits, debts, demands, or

damages, losses, liability or expense (including without limitation reasonable attorney’s fee) arising by reason of any actual or claimed

negligent or wrongful act or omission whether caused or allegedly caused by, in whole or in part, either myself, any third party, or any

party indemnified herein, regarding any loss suffered by me as a result of my participate in or use of the facilities. The City of De Pere

DOES NOT provide accident insurance for use of the facilities or engaging in fitness use.

Nothing contained herein is intended to be a waiver or estoppel of the City or its respective insurer to rely upon the limitations, defenses,

to me while using the facilities and engaging in fitness use. I understand the terms and conditions of this release and sign voluntarily.

_________________________________ ☐Employee ☐Spouse ☐Elected Official

Name

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Signature Date

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