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Weight Room Agreement

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HOLD HARMLESS AGREEMENT & ASSUMPTION OF RISK—USE OF POMEROY SCHOOL DISTRICT FACILITIES & EQUIPMENT—POMEROY WEIGHT ROOM

For and in consideration of the use of the facilities and equipment in the Pomeroy Weight Room, I (We) the undersigned, agree to hold the Pomeroy School District harmless and indemnity the Pomeroy School District for any loss that might arise of our (my) use of the facilities or equipment. I (We) understand that proper safety equipment must be used and proper lifting techniques must be followed to help reduce the risk of injury. I (we) understand that weight lifting is an activity that involves some risk of injury.

I (We) understand that the school district does not carry medical insurance for individuals using the weight room and that I (we) carry my (our) own medical insurance to be used in the event of an injury.

I have read and understand the rules of the Pomeroy School District Weight Room. I agree to abide by these rules and realize that failure to follow these rules may result in my being not allowed to use the Pomeroy Weight Room.

First and Last Name of Weight Room User:*

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Date of Birth:*

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Last Date of Physical:

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First and Last Name of Parent/Guardian if User is a Student:

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Today's Date*

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Confirmation Email

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