Rev. 01/04/2019
Johnston Community College
In consideration of the services of Johnston Community College, its Gym, its agents, owners, officers, volunteers,
participants, employees, and all other persons or entities acting in any capacity on its behalf (hereinafter
collectively referred to as JCC), I hereby agree to release, indemnify, and discharge JCC, on behalf of myself, my
children, my parents, my heirs, assigns, personal representative and estate as follows:
1. I acknowledge that my participation in fitness and wellness activities entails known and unanticipated risks,
which could result in physical or emotional injury, paralysis, death, or damage to myself, to property, or to
third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential
qualities of the activity. I am fully aware that at any time, I am free to withdraw from participation in fitness
and wellness activities. The risks include, among other things, the potential for: slips, falls and falling; rope
burns; pinches, scrapes, twists and jolts that could result in scratches, bruises, sprains, lacerations, fractures,
concussions, or even more severe life threatening hazards.
2. I understand that due to the seriousness of attempting new physical activities, it is in my best interest to consult
with my doctor before participating in any exercise program, especially in the event that I have a pre-existing
medical condition (i.e., heart condition, high blood pressure, allergies, disability, etc.), psychological
condition, am taking any prescription or non-prescription medication, and/or I do not already regularly
participate in physical exercise.
3. I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation
in this activity is purely voluntary, and I elect to participate in spite of the risks.
4. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless JCC from any and
all claims, demands, or causes of action, which are in any way connected with my participation in this activity
or my use of JCC equipment or facilities, including any such Claims which allege negligent acts or omissions
of JCC.
5. Should JCC or anyone acting on their behalf, be required to incur attorney's fees and costs to enforce this
agreement, I agree to indemnify and hold them harmless for all such fees and costs.
6. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating,
or else I agree to bear the costs of such injury or damage myself. I further certify that I am willing to assume
the risk of any medical or physical condition I may have.
7. In the event that I file a lawsuit against JCC, I agree to do so solely in the state of North Carolina, and I further
agree that the substantive law of that state shall apply in that action without regard to the conflict of law rules
of that state. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining
portions shall remain in full force and effect.
By signing this document, I acknowledge that if anyone is hurt or property is damaged during my
participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit
against JCC on the basis of any claim from which I have released them herein.
I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree
to be bound by its terms.
Signature of Participant _________________________________ Date ___________________________
Printed Name _________________________________________ Phone __________________________
Department/Job Title ___________________________________ Email __________________________
Emergency Contact __________________________________________________________________________
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