Unaccompanied Minor Access - Family Wellness Fargo

Non-member children ages 12 – 17 must have a legal parent or guardian present at the time of access or have the below Agreement for Unaccompanied Minor Access completed prior to gaining access. Children younger than 12 years of age must have a parent or guardian in the facility at all times. View the complete age guidelines here.

Agreement for Unaccompanied Minor Access

Dependent/Child’s Name(Required)

First Last

Dependent/Child’s Date of Birth(Required)

Parent/Legal Guardian’s Name(Required)

First Last

Parent/Legal Guardian’s Phone Number(Required)

EXPRESS ASSUMPTION OF RISK, WAIVER AND INDEMNIFICATION OF LIABILITY:(Required)

I represent that I and my family and guests, are physically able and qualified to participate in physical activities and the use of the facilities provided by Family Wellness, LLC. I acknowledge and agree that Family Wellness, LLC’s services and facilities used by myself and my family and guests are accepted “AS IS” and shall be undertaken at my sole risk. I understand that there is risk involved in physical activities, including risks of bodily injury, partial or total disability, paralysis and death, as well as other foreseeable and unforeseeable damages, including damage to property. I understand that there is also a very remote possibility that I might be exposed to bodily fluids (i.e., blood) which may contain the Hepatitis B agent or HIV virus. I knowingly and voluntarily acknowledge my full understanding of risks and assume such risks on behalf of myself and my family and guests. On behalf of myself and my family and guests, and our respective heirs, personal representative, administrators, and assigns, I hereby waive and relinquish any claims, rights and causes of action that I or my family or guests may have against Family Wellness, LLC, and its members, governors, officers, employees, agents, successors and assigns, for any injuries or damages to me or to my family or guests, arising out of the use of the Family Wellness, LLC services or facilities, whether or not arising from acts of active or passive negligence on the part of Family Wellness, LLC, its employees or agents. On behalf of myself and my family and guests, and our respective heirs, personal representatives, executors, administrators and assigns, I hereby agree to indemnify and hold harmless Family Wellness, LLC, and its members, governors, officers, employees, agents, successors and assigns, from any and all claims, demands, actions, costs or causes of action, including attorneys fees and costs of defense, relating to any such injuries and damage arising out of or resulting from my use, or use by my family or guests, of any of Family Wellness, LLC’s services or facilities wherever or however they occur. I hereby authorize Family Wellness, LLC’s employees to act in accordance with their best judgment in case of any injury or emergency that may occur for me, my family or my guests. Should medical care be necessary, I agree to pay the reasonable cost of such medical care or treatment.

AGREEMENT FOR MINORS(Required)

I am the parent/legal guardian of the minor child(ren) listed on this Family Wellness Agreement. I hereby agree to and enter into the above agreement for and on behalf of such child(ren), including the indemnification, assumption of risk, and release and waiver of liability provisions. For myself, and for and on behalf of my minor child(ren), other family members or guests, I agree to be bound by the waiver, indemnification and hold harmless provisions above described.

CODE OF CONDUCT:(Required)

I represent that I and my family and guests, will abide by the Family Wellness, LLC, Code of Conduct, and will observe its conduct guidelines in regards to respecting other people’s rights, space, and belongings. I also understand the age guidelines of the facility, and agree to abide by them.

Parent/Legal Guardian’s Signature(Required)

I certify that by typing the parent/legal guardian’s name below, the individual submitting the online Agreement for Unaccompanied Minor Access acknowledges understanding and agrees to all the terms of this Family Wellness Agreement.

Parent/Legal Guardian’s Signature(Required)

First Last