Fill and Sign the Agreement Personal Injury Form

AGREEMENT AND RELEASE FORM FOR TANNING FACILITY USE This Agreement is made and entered into this the ____day of ___________, 20___ by and between _____________________________________________(hereinafter A Company @ ) and ________________________________________(hereinafter A Customer @ ) and is subject to the following terms and conditions: 1. Non-transferable. Customer and Company agree that the rights granted to Customer hereunder may not be transferred, assigned or conveyed to any other person. 2. Term. The term of this Agreement shall extend for a period of _______ months beginning on the ______ day of ____________, 20____. This agreement shall then be automatically be extended on a monthly basis unless terminated by Customer or Company. After the initial term, this agreement may be cancelled by Customer or Company upon 30 days notice. 3. Consideration. In full consideration of a monthly payment of $_____________by Customer and subject to the other terms and conditions of this Agreement, Company shall provide access and allow unlimited visits by Customer to use the tanning facilities operated by Company at (address of facility). 4. Independent Advice. Customer represents and warrants that he/she has been advised that exposure to tanning devices carries certain health risks and potential side effects. Customer further represents and warrants that he/she have had the opportunity to seek independent medical or other advice about the risks associated with indoor suntanning and exposure to tanning devices prior to signing this Agreement. 5. Release and Indemnity. Customer hereby releases, discharges and shall hold Company harmless, including its successors, agents, assigns, employees and representatives from any and all claims, demands, damages, actions or suits of any kind whatsoever and including but not limited to the causation, exacerbation or increase in risk of any adverse health condition, whether known or unknown, as a direct or indirect result of Customer = s use of tanning equipment and facilities furnished by Company. 6. Rules and Regulations. Customer agrees to abide by all rules and regulations that may from time to time by adopted by Company governing the use of the tanning facilities of Company. 7. Entirety. This instrument supersedes any prior negotiations, discussions or agreements and sets forth the entire agreement between the parties with respect to this subject matter. No modification shall be binding unless confirmed by a written instrument signed by both parties. 8. Applicable Law. The parties hereto agree that this Agreement is to be enforced and construed according to the laws of the State of _________________ and, in the event that any portion of this Agreement is set aside by a court of competent jurisdiction, the balance shall remain in full force and effect to the extent feasible. WITNESS OUR SIGNATURES, the day and date first above written. ________________________ _________________________ Company Customer Waiver and Release by Legal Guardian or Parent I hereby represent that I am the parent or legal guardian of the Customer (who is under the age of 18 years) and am authorized to execute this Release. I do further agree and represent that: a. Customer is physically able to safely use said tanning facilities; b. I have read this document; c. I have inspected the tanning facilities and equipment and accept them as being safe and reasonably suited for the purposes intended; and d. I voluntarily signed this Waiver and Release. In consideration of said minor customer being allowed to use the facilities of Company, I, on behalf of myself and said minor customer, release the Company, its directors, officers, employees and volunteers (collectively A Releasees @ ) from all liability to me or minor customer for any loss or damage to property or injury or death to minor customer whether caused by Releasees or otherwise that result, directly or indirectly form the use of minor customer of said tanning facilities operated by Company. I further agree to indemnify, save and hold Releases harmless from any loss, liability, attorneys = fees, damage, or costs that they (or any of them) may incur arising out of or related to the use of said tanning facilities by minor customer whether caused by the negligence of the Releasees or otherwise. ___________________ Parent or Guardian of Minor Customer Date STATE OF ________________________ COUNTY OF ______________________ Personally appeared before me, the undersigned authority in and for the said County and State, on this day of _____________, 20___, within my jurisdiction, the within - named ________________________., who acknowledged that he/she executed the above and foregoing instrument. ___________________________________ NOTARY PUBLIC My Commission Expires: