I, the undersigned (Participant) wish to participate in the BodySTARR LLC Group Fitness Programs. (hereinafter the "Program").
In order that I may receive medical treatment in the event of an emergency whereby I may sustain injury or illness during participation in the Program, I authorize any BodySTARR LLC employee to consent to and to request on my behalf medical treatment including x-rays, examination, anesthetic, medical or surgical diagnosis or treatment or hospital care for such an injury or illness during my participation in the Program and I hereby release, discharge, indemnify and agree to hold BodySTARR LLC, Stacey R. Long and their partners, affiliated companies and entities, subsidiaries, agents, representatives, successors, predecessors, assigns, directors, officers, employees, shareholders, heirs, beneficiaries, spouses and attorneys (collectively the The Parties) harmless in the exercise of such authority. I further hereby acknowledge that the The Parties have no obligation to seek any treatment whatsoever on my behalf.
Should the need arise; the following information may be given to any health care provider: