Fitness Center Waiver/Release Covenant Not to Sue and Indemnity Agreement User Name Expiration Date MM slash DD slash YYYY Address Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home PhoneWork PhoneEmployer I/User enter into this Fitness Center Waiver Release, Covenant not to Sue and Indemnity Agreement ("Agreement") with Banbury Place, Inc., 323 Dewey St. North, P.O. Box 0203, Eau Claire, WI 54702-0203 ("Banbury"), for the privilege to use the Fitness Center ("Center") located at 800 Wisconsin Street, Building DO2, Suite 268, Eau Claire, WI 54703 based on the following terms and conditions:1. Waiver and Release of All Claims (Including Negligence)IN CONSIDERATION FOR USE OF THE CENTER, I/USER WAIVE AND RELEASE BANBURY PLACE, INC., ITS AGENTS, SERVANTS, EMPLOYEES, INSURERS, SUCCESSORS, AND ASSIGNS (HEREAFTER BANBURY) FROM ALL CLAIMS, DEMANDS, CAUSES OF ACTION, DAMAGES OR SUITS AT LAW AND EQUITY OF WHATSOEVER KIND, INCLUDING BUT NOT LIMITED TO CLAIMS FOR PERSONAL INJURY, PROPERTY DAMAGE, MEDICAL EXPENSES, LOSS OF SERVICES, ON ACCOUNT OF OR IN ANY WAY RELATED TO OR GROWING OUT OF MY PRESENCE AT THE CENTER OR USE OF THE CENTER AND /OR EQUIPMENT. THIS WAIVER AND RELEASE IS INTENDED TO AND DOES RELEASE BANBURY PLACE FROM ANY AND ALL LIABILITY FOR DAMAGES OR INJURIES ON ACCOUNT OF OR IN ANY WAY RELATED TO OR GROWING OUT OF MY NEGLIGENCE, THE NEGLIGENCE OF THIRD PARTIES, AND BANBURY'S NEGLIGENCE, INCLUDING BUT NOT LIMITED TO NEGLIGENCE IN THE CONSTRUCTION, MAINTENANCE AND UPKEEP OF THE CENTER AND ITS EQUIPMENT, NEGLIGENCE IN TRAINING, NEGLIGENCE IN SUPERVISION, VIOLATION OF THE SAFE PLACE STATUTE. THIS IS NOT INTENDED TO RELEASE BANBURY FROM ANY LIABILITY RESULTING FROM THEIR INTENTIONAL CONDUCT.Signature* I/User understand that if, for any reason, I am or have been under medical supervision or if I have not exercised regularly in the recent past, that a doctor's approval should be obtained prior to my use of the Center's equipment. I understand and agree that it is my sole responsibility to obtain a doctors approval, and I hold Banbury harmless therefore. I/User further covenant and agree not to institute any claims or legal action against Banbury for any claim released by this Agreement. I further agree that should any claim by made against Banbury in contravention of this Agreement, including, but not limited to derivative claims, I will protect, defend, and completely indemnify (reimburse_ Banbury for any such claim and expenses including attorneys' fees and costs incurred by Banbury in defending themselves or securing indemnity hereunder. I/User recognize the Center is not supervised and I use the Center (including the premises and equipment) entirely at my own risk.* I certify that this is my authorized signature. 2. Fitness Center Use I/User will receive a nontransferable Key and Center Card with a Personal Access Code which must be used to access the Center. A $10 Key Deposit is required. Upon return of the key to Banbury Place, the $10 Key Deposit will be returned to User. Only User may use the Center. Any transfer or attempted transfer of the Key and/or Card with Personal Access Code is void and terminates this Agreement, at which time User shall forfeit all dues paid. The provisions of this Agreement apply to any extension of the Expiration Date. There are "no refunds" for early cancellation of Center use.User may use the Center During regular posted hours from the date of execution of this Agreement through the Expiration Date listed above (or any paid extensions thereof) upon payment of dues as follows: $20 per One Month Period $105 per Six Month Period $185 per Twelve Month Period (1 Year) Employer/Company Plan Company 3. Locker Rental (Optional)I/User will provide my own paddle lock and agree to keep my assigned locker locked when not in use, clean and free from any nuisance odors. $10 per One Month Period $50 per Six Month Period $75 per Twelve Month Period Locker #123456789101112131415161718192021222324254. Lost/Stolen Valuables/Property Center is not responsible for any lost or stolen valuables or property. Banbury has a lien on all property stored in any locker and may satisfy such lien by selling the property, as provided in Wis Stat 704.90, if user defaults or fails to pay dues for storage of property abandoned after termination of this agreement. All abandoned property will be placed in the "Lost and Found" located within the Center. All properties not claimed within one month will be donated to a local charity.5. Code of ConductWhile at the center I/User agree to conduct myself in a responsible manner, and shall refrain from engaging in inappropriate conduct, including the use of loud, foul, slanderous language, or any intimidating or offensive conduct which would interfere with the peaceful use and enjoyment of the Center by other users.6. Rules and/or RegulationsI/User agree to comply with all notices, rules and/or regulations posted in the Center.7. Drugs and Alcohol AgreementAny illegal drugs, alcoholic beverages, intoxicants and criminal conduct is prohibited in the Center.9. Change of Hours/Program/StaffThe Center reserves the right to alter, modify and/or change its hours of business, as well as any equipment, programs and/or staff without notice to user.9. Change of Hours/Program/StaffThe Center reserves the right to alter, modify and/or change its hours of business, as well as any equipment, programs and/or staff without notice to user.ACKNOWLEDGMENTI/User have been provided with an opportunity to review the foregoing Agreement and to have the Agreement reviewed by legal counsel of my choosing. I have read the Agreement and understand that by signing the Agreement I have consented to be bound by its terms, including the waiver/release of any legal right I may have to sue Banbury for any injuries or damages I may sustain and my obligations to reimburse Banbury for any costs, including attorneys' fees they incur because a claim or legal action is brought in violation of this Agreement. I/User agree any violation of the foregoing Agreement and its terms and conditions, as determined by Banbury, shall void and terminate this Agreement, at which time I/User shall forfeit all dues, rental fees and deposits paid. Applicant Signature* I certify that this is my authorized signature.Date MM slash DD slash YYYY Four Digit User Access CodeKey Deposit (if renting locker)Please submit the form online or print out this from and mail it in. Once we receive your application we will contact you for billing information. The completion and submission of the COVENANT NOT TO SUE AND INDEMNITY AGREEMENT electronically does not constitute a binding agreement for the rental of the requested storage unit. Only upon the completion and signature of an original COVENANT NOT TO SUE AND INDEMNITY AGREEMENT shall the agreement be binding.