LML Exercise Waiver

First

Last

Phone Number

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Emergency Contact Name

Emergency Contact Phone Number

Please select the program(s) you will be attending

When submitting this form you must agree to the following:

I acknowledge that I am voluntarily participating in a physical activity/program sponsored by the Lindenhurst Memorial Library.

I assume all risks associated with this type of physical activity/program, and I waive any right I may have to a claim or claims against the library for personal injury or property damaged sustained by me, by any cause whatsoever.

I further agree to indemnify and hold harmless the library for an injury to persons or property caused by me while participating in this activity.

I will consult with my physician before beginning this physical activity/program.