Waiver & Release

Participant Waiver & Release

Before participating in any Retro Active class, program, event, or service, every participant must complete this waiver. Once submitted, a copy of the completed waiver will be securely stored for both the participant and Retro Active for our records.

Participant Information

Medical Information

Please list allergies, implanted medical devices, recent surgeries, or other health concerns.

Mobility Status

Waiver Agreement

Please review the full waiver text below.

Voluntary Participation

I understand that my participation in any Retro Active class, program, event, or service is entirely voluntary. I may modify, pause, or stop any activity at any time.

Acknowledgement of Physical Activity

I acknowledge that Retro Active programming involves physical movement, including but not limited to seated exercise, dance, drumming, stretching, coordination games, and light strength work, all of which carry inherent risk of injury.

Physician Approval

I confirm that I have consulted my physician about any medical conditions that could be affected by participation and have received appropriate approval to take part in senior fitness or enrichment activities.

Participant Responsibilities

I agree to disclose relevant medical conditions and mobility limitations, wear appropriate clothing and closed-toe shoes, bring water when appropriate, and notify the instructor immediately if I experience pain, dizziness, or discomfort.

Medical Disclaimer

Retro Active instructors are fitness and enrichment professionals, not licensed medical providers. Nothing offered by Retro Active is medical advice, diagnosis, or treatment.

Assumption of Risk

I knowingly and voluntarily assume all risks associated with participation, including but not limited to muscle strain, fatigue, falls, slips, injury, aggravation of pre-existing conditions, or medical emergencies.

Release of Liability

To the fullest extent permitted by law, I release, waive, and discharge Retro Active, its founder, employees, contractors, and affiliates from any and all claims, demands, or causes of action arising from my participation.

Indemnification

I agree to indemnify and hold harmless Retro Active from any losses, claims, or expenses arising out of my participation or my failure to disclose relevant medical information.

Medical Emergency Authorization

In the event of a medical emergency and if I am unable to communicate, I authorize Retro Active staff to contact my emergency contact and to summon emergency medical services on my behalf.

Medication Disclaimer

Retro Active instructors do not administer, remind, dose, or advise on medications. Any and all medication decisions remain the responsibility of the participant and their care team.

Personal Property Disclaimer

Retro Active is not responsible for loss, theft, or damage to personal property brought to any session or event.

Transportation Disclaimer

Retro Active does not provide transportation for participants and is not responsible for transportation arrangements to or from any session.

COVID & Communicable Illness Acknowledgement

I acknowledge the inherent risk of exposure to communicable illnesses, including COVID-19, whenever people gather. I agree not to attend if I am experiencing symptoms of illness.

Electronic Signature Agreement

I agree that typing my full legal name below constitutes a valid electronic signature with the same legal effect as a handwritten signature.

Entire Agreement

This waiver constitutes the entire agreement between me and Retro Active regarding participation and supersedes any prior discussions or communications.

Governing Law (Indiana)

This agreement is governed by the laws of the State of Indiana. Any dispute arising under it will be resolved in the appropriate courts of Indiana.

Participant Certification

I certify that I am at least 18 years of age (or the legal guardian of the participant), that I have read this waiver in its entirety, and that I am signing freely and voluntarily.

Required Acknowledgements

Electronic Signature

Photography & Media Release

I authorize Retro Active to photograph or record me during activities for promotional, educational, website, and social media purposes.

Please check all required acknowledgements to submit.