Child's Name First Name Last Name Please Sign Your Name * PARENTAL CONSENT, RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT IN CONSIDERATION of my minor child(ren) (the “Minor”) being permitted to attend and participate in the Remix Fitness Lil’ Remix Kids services, and intending to be legally bound, I hereby agree: 1. I FULLY UNDERSTAND that (a) Remix Fitness Lil’ Remix Kids services are provided only when I am present in the building and taking class, and I am not permitted to leave the premises; (b) Remix Fitness Lil’ Remix Kids is a drop-in babysitting facility and is NOT REQUIRED to be licensed and/or regulated by the Commonwealth of Pennsylvania; and (c) I am not to bring a sick child to Remix Fitness Lil’ Kids. For the purposes of this agreement, sick includes, but is not limited to, a fever of 100 degrees Fahrenheit or higher, vomiting, diarrhea, earache, runny nose (not clear), discharge from the eye, or open sores. 2. I consent to the Minor’s participation in Remix Fitness Lil’ Remix Kids and hereby accept and assume all such risks, known and unknown, and assume all responsibility for the losses, costs, and/or damages following physical injury or property damage, even if caused, in whole or in part, by the negligence of the “Releasees” named below. 3. I hereby release, discharge, and covenant not to sue Remix Fitness, LLC, its employees, workers, officers, representatives, agents, organizers, and successors (the “Releasees”) from all liability to me, the Minor, my and the Minor’s personal representatives, assigns, heirs, and next of kin, for any and all claims, demands, losses, or damages on account of any injury, including, but not limited to, death or damage to property, caused or alleged to be caused, in whole or in part, by the negligence of the Releasees or otherwise. 4. If, despite this release, I, the Minor, or anyone on the Minor’s behalf, makes a claim against any of the Releasees named above, I agree to indemnify and save and hold harmless the Releasees and each of them from any litigation expenses, attorney fees, loss, liability, damage, or cost they may incur due to the claim made against any of the Releasees named above, whether the claim is based on the negligence of the Releasees or otherwise. 5. This Parental Consent, Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement shall be governed by the laws of the Commonwealth of Pennsylvania. All parties hereto consent to exclusive venue in state and federal courts in Montgomery County, Pennsylvania. 6. This Parental Consent, Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement constitutes the entire agreement of the parties and supersedes all prior agreements and/or memoranda. 7. This agreement may only be modified in writing with the written consent of both parties. 6. I sign this agreement on my own behalf and on behalf of the Minor I HAVE READ THIS PARENTAL CONSENT, RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, UNDERSTAND THAT BY SIGNING IT I GIVE UP SUBSTANTIAL RIGHTS I AND/OR THE MINOR WOULD OTHERWISE HAVE TO RECOVER DAMAGES FOR LOSSES OCCASIONED BY THE RELEASEES’ FAULT, AND SIGN IT VOLUNTARILY WITHOUT INDUCEMENT. First Name Last Name Date * MM DD YYYY Email Phone (###) ### #### Thank you!