Roots Academy Use Please fill out the form below. Parent Name* First Last Student's Name* First Last Student's Date of Birth* MM slash DD slash YYYY Email* Phone*PARENT OFFER: I would like to take advantage of a FREE WEEK PASS at the Courthouse.*A coach will be in contact with you to get this set up! Yes, I would love to try the Courthouse No, thank you WAIVER AND RELEASE OF LIABILITY FOR USE OF COURTHOUSE FACILITIES AND PROVISION OF FITNESS GUIDANCE BY STAFFI desire to utilize or participate in the facilities, equipment, activities (including without limitation, leagues and tournaments), athletic, fitness and nutrition training and/or any other services (collectively, the “Services”) provided by Capitol Racquet Sports, Inc. dba Courthouse (“Courthouse”). In consideration of utilizing or participating in the Services provided by Courthouse, I hereby agree to and acknowledge the terms of this waiver and release of liability (the “Release”). To the extent that my minor child(ren) desires to utilize or participate in the Services provided by Courthouse, I hereby agree to and acknowledge the terms of this Release on behalf of my minor child(ren).GENERAL PARTICIPATIONDISCLAMER: COURTHOUSE IS NOT RESPONSIBLE FOR ANY INJURY, DAMAGE TO OR LOSS OF PROPERTY TO ANY PERSON SUFFERED WHILE BEING ON THE PREMISES OR USING THE FACILITIES, SERVICES, AND/OR EQUIPMENT IN ANY WAY AND FOR ANY REASON WHATSOEVER, INCLUDING ORDINARY NEGLIGENCE ON THE PART OF COURTHOUSE, ITS AGENTS, CONTRACTORS OR EMPLOYEES.I hereby release and covenant not-to-sue Courthouse, its owners, affiliated companies, contractors, employees, instructors, agents and all others who are involved with the Courthouse (collectively, “Courthouse Parties”) from any and all present and future claims that may arise out of or relate to my use or intended use of or participation in the Services provided by the Courthouse, or my engaging in any training, athletic or non-athletic activity incidental thereto, wherever, whenever, or however the same may occur. I hereby voluntarily waive any and all claims resulting from ordinary negligence, both present and future, and whether known, anticipated or unanticipated, that may be made by me, my family, estate, executors, administrators, heirs, or assigns. I ACKNOWLEDGE THAT THIS RELEASE SHALL PREVENT ME FROM SEEKING DAMAGES OR OTHER RELIEF IN A COURT OF LAW OR OTHERWISE. The scope of this Release shall be read as broadly as allowed by law in favor of releasing the Courthouse and the Courthouse Parties, and shall include, but not be limited to, negligence on the part of Courthouse or the Courthouse Parties and any and all other conceivable claims for personal injury and/or property damage.I further agree to indemnify and hold harmless Courthouse Parties from and against any and all claims, actions, lawsuits, costs and expenses (including attorney fees) arising as a result of my engaging in or receiving instruction in any Courthouse activities or any activities incidental thereto, wherever, whenever, or however the same may occur.FITNESS GUIDANCE FROM COACHES OR TRAINERSIncluded within the definition of Services, Courthouse offers various forms of fitness training that provide an opportunity to improve strength, cardiovascular fitness, flexibility, diet, and other selected components of physical fitness (herein referred to as “Courthouse Training” or “Training”). Courthouse members may work with one or more staff persons, and may also receive guidance provided by other Courthouse staff, such as a Fitness coach, instructor or others (collectively, a “Trainer”).Depending on the specific program, a Trainer will provide instruction, supervise activity, and monitor progress to varying degrees, which may include physical touching or manipulation. However, regardless of the reasonable care taken by a Trainer in providing appropriate equipment, instruction, and supervision, accidents and injuries can occur.Training activities may include, without limitation the following:Strength-building activities include exercises to develop the strength of various muscle groups. Strength building activities place additional and unusual demands upon the body since they involve strenuous maximal, or near maximal, exertions of force using various muscle groups. Cardiovascular activities also place additional demands upon the body since they generally involve prolonged moderate to vigorous exercise. All activities utilized for developing cardiovascular fitness involve sustained physical activity that places significant stress on the cardiovascular system. Additionally, all types of exercise equipment carry with them risks due to user misuse as well as those of equipment failure. Likewise, both flexibility and fitness testing carries with it certain inherent risks due to the strenuous, and sometimes maximal, effort required. Adhering to a nutritional program that causes you to change the timing, frequency, daily caloric intake, and type of foods you consume can pose a risk due to the response each person’s body has to various foods or supplements. Injuries or illness can be a result of any number of inherent risks of all forms of Training, including such factors as excess stress during training or testing activities, inadvertent user inattention, unexpected equipment failure, inadvertent Trainer error, and misjudgments of client ability by the client or the Trainer. If you have questions regarding the benefits or risks of these or other activities, please consult with your Trainer.ASSUMPTION OF RISKI am aware that using or participating in the Services provided by Courthouse involves the risk that accidents, minor or severe, may occur. I understand that certain dangers may arise resulting from or arising out of my use or intended use of Courthouse facilities, services, and/or equipment, including but not limited to, death, heart attacks, serious neck and spinal injuries resulting in paralysis, and injury to virtually all bones, joints, muscles, and internal organs and that equipment provided for my protection may be inadequate to prevent serious injury. In addition, I understand that participation in Courthouse activities may involve travel to and from the site of the activity, participation at sites that may be remote from available medical assistance, and include the possible reckless conduct of other participants. I am voluntarily participating in the activities with knowledge of the potential dangers and hereby agree to accept and assume any and all inherent risks of property damage, personal injury, or death.I further understand that the inherent risks of the Services (including activities in and activities outside of Courthouse) vary with the activity, the setting, the muscle group involved, and the exercise equipment used. Common minor risks include muscle strains, muscle sprains, muscular fatigue, contusions, and post-exercise soreness. More serious, but less frequent, risks include joint injuries, torn muscles, heat-related illnesses, and back injuries. There is also the more remote risk of a catastrophic incident (e.g., stroke, heart attack, paralysis, or death).I have read the previous paragraphs, I have discussed the risks with my Trainer or other Courthouse staff as I deem necessary, and I know and understand the nature of the Services. I understand the demands of those activities relative to my condition and skill level, and I appreciate the types of injuries that may occur as a result of the Services that I have selected and their potential impact on my well-being and lifestyle. I hereby assert that my participation is voluntary and that I knowingly assume all such risks.REPRESENATIONS, ASSERTIONS, CONSENTS AND AGREEMENTSI represent that I will only engage in the Services in which I am sufficiently physically fit to participate.I assert that I have no health problems that should prevent me from utilizing or participating in the Services.I acknowledge that Courthouse and my Trainer recommend that I get medical clearance from my personal physician prior to participating in the Services, especially if I am currently being treated for a medical condition or using medication.I assert that I possess a sufficient level of physical fitness to enable me to safely participate in the Services.I give consent to certain physical touching that may be necessary to ensure proper technique during exercise or to conduct certain fitness tests or evaluations.I authorize Courthouse to administer emergency first aid, CPR, and use an AED.I authorize Courthouse to secure emergency medical care or transportation (i.e., EMS).I authorize Courthouse to share my medical history with emergency medical personnel.I authorize Courthouse to utilize audio and video data information from recording equipment present in various areas of Courthouse facilities.I agree to assume all costs of my medical care and transportation.I acknowledge that it is my duty to inform Courthouse and cease exercise immediately if I should feel any unusual discomfort (e.g. faintness, shortness of breath, high anxiety, chest pains) or if I feel that the activity is inappropriate for me, whether during testing, strength training, cardiovascular training, or any other activity.I acknowledge that Courthouse will conduct all activities in good faith and may find it necessary to terminate my participation in an activity when Courthouse Parties or a Trainer judges me to be incapable of safely meeting the rigors of the activity. I accept Courthouse’s right to take such actions for my safety and/or the safety of other parties.This Release applies to personal injury (including death) from incidents or illnesses arising from my participation in or utilization of the Services including without limitation, any league, tournament, or activity planned by my Trainer as a part of any Courthouse Training program or Services, including, but not limited to, organized training activities, fitness tests, classes, individual use of facilities or equipment, nutritional plan, shower/locker room area, all premises including the associated sidewalks and parking lots.In addition to any other agreements or covenants set forth herein, I covenant not to sue Courthouse Parties, my Trainer, other employees, agents for any present or future claim I might have. This includes claims resulting from; 1) the inherent risks of physical conditioning and changes to dietary habits, and; 2) the negligence of Courthouse, my Trainer(s), and other Courthouse Parties.ACKNOWLEDGEMENT OF TERMSI understand that this Release cannot be modified or changed in any way by representations or statements by any agent or employee of the Courthouse. This agreement may only be amended by a written document duly executed by me and an authorized representative of Courthouse.I agree to engage in good faith efforts to mediate any dispute that might arise. Any agreement reached will be formalized by a written contractual agreement at that time. Should the issue not be resolved by mediation, I agree that all disputes, controversies, or claims arising out of or relating to this contract shall be submitted to binding arbitration in accordance with the applicable rules of the Arbitration Service of Portland, Inc. then in effect.I understand that this waiver is intended to be as broad and inclusive as permitted by the laws of the State of Oregon and agree that if any portion is held invalid, the remainder of the waiver will continue in full legal force and effect. I further agree that the venue for any legal proceedings shall be in Marion County, Oregon.I have read this Release and fully understand its terms. I understand that I am giving up substantial rights, including my right to sue. I further acknowledge that I am signing the agreement freely and voluntarily, and intend my signature to be a complete and unconditional release of all liability, including that due to ordinary negligence by Courthouse, to the greatest extent allowed by law in the State of Oregon.I affirm that I am of 18 years of age and am freely signing this Release I have read this form and fully understand that by signing this form, I am giving up legal rights and/or remedies which may be available to me for the ordinary negligence of Courthouse or any of the parties listed above.CONSENT AND RELEASE OF PARENT OR LEGAL GUARDIAN:I represent that I am the parent or legal guardian of a minor (hereinafter “my Child”) using Courthouse facilities, services or equipment. My Child is physically and mentally able to use the facilities, services and equipment. I have read and understand this Release. I agree that the terms of this Release shall bind me and my Child to the same extent as if I signed this Release. I agree that the above acknowledgments are true and correct. I will, on behalf of my Child, ensure that any investigation or action required by this Release is performed.Unusual ClosuresHours of operation are subject to reasonable adjustment at the discretion of Courthouse management, including but not limited to changes for holidays, special occasions and for the performance of maintenance to facilities. Whenever possible, notice of such changes will be posted on Courthouse premises and/or website. Should all Courthouse facilities be unavailable for Member use for a period exceeding seven days due to damage by fire, act of God, catastrophe, accident, construction or extraordinary maintenance, the membership time for Member shall be extended for a like period.Right to Deny MembershipCourthouse shall have the right to terminate a membership whenever management determines, in its sole discretion, that the continued existence of the membership is no longer in the best interest of Courthouse or other members. The following non-exclusive list of occurrences may constitute the basis for termination of a membership: when Member violates a Courthouse policy, procedure, or condition of membership; when Member abuses, destroys, or wrongfully damages Courthouse premises or property, which includes it’s business reputation; when Member abuses, verbally or physically harasses, threatens, intimidates, or defames other members or Courthouse employees; when Member engages in theft of any property belonging to Courthouse or to a member or visitor; or when Member engages in the unauthorized use of, or conducts unauthorized activities on Courthouse premises.Annual Facility Enhancement FeeThe Courthouse Club Fitness annual facility enhancement fee will be assessed once a year on the anniversary of the members join date. This fee will help to supplement improvements and additions to Courthouse facilities. Courthouse retains the right to raise this fee at its sole discretion.Closing Membership AccountA member may resign their membership only by issuance of written notification. A minimum of 30 days advance notice is required, as long as their commitment has been met. Ceasing to use club facilities will not be considered as notice of intent to resign membership, nor will ceasing to pay monthly dues. Written notification must be submitted in person on a club form, online, or sent by certified mail. CLICK HERE to resign.Oregon Law Governing Health Club MembershipIF YOU WISH TO CANCEL THIS AGREEMENT, WITHOUT PENALTY, YOU MAY CANCEL IT BY DELIVERING OR MAILING BY CERTIFIED MAIL A WRITTEN NOTICE TO COURTHOUSE. THE NOTICE MUST SAY THAT YOU DO NOT WISH TO BE BOUND BY THE AGREEMENT AND MUST BE DELIVERED OR MAILED BEFORE MIDNIGHT OF THE THIRD BUSINESS DAY AFTER YOU SIGN THIS AGREEMENT. THE NOTICE MUST BE MAILED TO: COURTHOUSE, P.O. BOX 3125, SALEM, OREGON 97302. IF YOU CANCEL WITHIN THREE DAYS, COURTHOUSE WILL RETURN TO YOU WITHIN 15 DAYS ALL AMOUNTS YOU HAVE PAID.In addition, you may cancel this Agreement for the following reasons: a) if you die or become physically unable to use a substantial portion of those health club services used by you from the date of this membership agreement until the time of disability. Your disability must be confirmed by an examination of a physician agreeable to you and Courthouse. b) If Courthouse goes out of business. c) If Courthouse moves its facility closest to your residence on the date of the Membership Agreement to a location more than five additional miles from that residence. d) If a facility, construction or improvement is not completed by the date represented in the membership agreement. e) If Courthouse materially changes the health club services promised as part of the initial Membership Agreement.If you choose to cancel your Membership Agreement for reasons a) through e) stated above, you will receive a refund of any dues paid, up to an amount computed by dividing the total amount of dues paid in the month of cancellation by the number of weeks in the month for which the dues were paid and multiplying the result by the number of weeks remaining in the month. The reasonable administrative costs associated with the establishment of your membership, including any joining fee, will not be refunded. Any liquidated damage clause mentioned in this agreement will not apply to memberships that are terminated under the conditions mentioned above.Email Communication PolicyCourthouse communicates all official notices and updates via email. Consent I agree to the policy stated above.