intake forms

let's get started

Please submit the intake form and waiver of liability.

Pivot Peak Performance Assumption of Risk, Release Waiver of Liability, and Indemnity Agreement
Pivot Peak Performance Assumption of Risk, Release Waiver of Liability, and Indemnity Agreement In consideration for being permitted to utilize the services and equipment of Boles Family, LLC, dba Pivot Peak Performance, and/or for my children listed above to so participate for any purpose, including, but not limited to, observation or use of facilities or equipment, or participation in any off-site program affiliated with Pivot Peak Performance. The undersigned, on behalf of himself or herself and such participating children and any personal representative, heirs, and next of kin (hereinafter referred to as “the undersigned”) hereby acknowledges, agrees and represents that he or she has inspected and carefully considered such premises, equipment and facilities and/or the affiliated programs and that the undersigned finds and accepts same as being sage and reasonably suited for the use or participation by the undersigned and such participating children. In addition, the undersigned acknowledges that novel coronavirus (COVID-19”) infections have been confirmed throughout the United States, including cases in Texas and Johnson County. In accordance with the most recent guidance and protocols issued by the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), the Texas Department of Health (TDH) for slowing the transmission of COVID-19, the undersigned hereby agrees, represents, and warrants that neither the undersigned nor such participating children shall visit or utilize the facilities, services, and programs of Pivot Peak Performance (other than any exclusively online services and programs) within 14 days after (i) returning from highly impacted areas subject to a CDC Level 3 Travel Health Notice (ii) exposure to any person returning from areas subject to a CDC Level 3 Travel Health Notice, or (iii) exposure to any person who has a suspected or confirmed case of COVID-19. The CDC Travel Health Network is continuously updating this list and the undersigned agrees that they are aware of this list and the countries listed. The undersigned agrees to check the CDC Travel Health Notices list (https://www.cdc.gov/coronavirus/2019-ncov/travelrs/index.html) prior to utilizing the facilities, services and programs of Pivot Peak Performance, on a daily basis if necessary. The undersigned hereby agrees, represents, and warrants that neither the undersigned nor such participating children shall visit or utilize the facilities, services, and programs of Pivot Peak Performance if he or she (i) experiences symptoms of COVID-19, including, without limitation, fever, cough or shortness of breath, or (ii) has a suspected or diagnosed/confirmed case of COVID-19. The undersigned agrees to notify Pivot Peak Performance, Shauna Boles, immediately if he or she believes that any of the foregoing access/use restrictions may apply. Pivot Peak Performance, Shauna Boles, has taken certain steps to implement recommended guidance and protocols issued by the Public Health Agencies for slowing the transmission of COVID-19, including, without limitation, the access/use restrictions set forth above. The undersigned acknowledges and agrees that Pivot Peak Performance may revise its procedures at any time based on updated recommended guidance and protocols issued by the Public Health Agencies and further agrees to comply with Pivot Peak Performance’s undersigned revised procedures prior to utilizing the facilities, services, and programs of Pivot Peak Performance. The undersigned further acknowledges and agrees that, due to the nature of the facilities, services and programs offered by Pivot Peak Performance, social distancing of 6 feet per person is not possible. The undersigned fully understands and appreciates both the known and potential dangers of utilizing the facilities, services, and programs of Pivot Peak Performance and acknowledges that use thereof by the undersigned and/or such participating children may, despite Pivot Peak Performance, Shauna Boles’, reasonable efforts to mitigate such dangers result in exposure to COVID-19, which could result in quarantine requirements, serious illness, disability, and/or death. IN FURTHER CONSIDERATION OF BEING PERMITTED TO ENTER PIVOT PEAK PERFORMANCE FACILITY FOR ANY PURPOSE INCLUDING, BUT NOT LIMITED TO, OBSERVATION OR USE OF FACILITIES OR EQUIPMENT, OR PARTICIPATION IN ANY ON-SITE OR OFF-SITE PROGRAM AFFILIATED WITH PIVOT PEAK PERFORMANCE, THE UNDERSIGNED HEREBY AGREES TO THE FOLLOWING: THE UNDERSIGNED, ON HIS OR HER BEHALF AND ON BEHALF OF SUCH PARTICIPATING CHILDREN, HEREBY RELEASES, WAIVES, DISCHARGES, AND COVENANTS NOT TO SUE BOLES FAMILY, LLC, dba, PIVOT PEAK PERFORMANCE, its directors, officers, and agents from all liability to the undersigned or such participating children and all personal representatives, assigns, heirs, and next of kin of the undersigned or such participating children for any loss or damage, and any claim or demands on account of any property damage or any injury to or an illness or the death of, the undersigned or such participating children (or any person who may contract COVID-19, directly or indirectly, from the undersigned or such participating children) whether caused by the negligence, active or passive, of Pivot Peak Performance or otherwise while the undersigned or such participating children are in, upon, or about the premises or any facilities or equipment therein or participating in any program affiliated with Pivot Peak Performance. The undersigned expressly and knowingly waives all rights under California Civil Code Section 1542, which provides: “A general release does not extend to claims that the creditor or releasing party does not know or suspect to exist in his or her favor at the time of executing the release and that, if known by him or her, would have materially affected his or her settlement with the debtor or released party.” THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS BOLES FAMILY, LLC, dba PIVOT PEAK PERFORMANCE, its directors, officers, and agents, and each of them from any loss, liability, damages or costs they may incur, whether caused by the negligence, active or passive, or otherwise while the undersigned or any participating child is in, upon or about the premises or any facilities or equipment therein or participating in any program affiliated with Pivot Peak Performance. The undersigned understands and agrees that Pivot Peak Performance, Shauna Boles, is not required to provide insurance to cover the undersigned or such participating children in the event they suffer illness, injury, death, property loss, theft or damage of any sort upon, or about the premises or any facilities or equipment therein or participating in any program affiliated with Pivot Peak Performance. The undersigned agrees and acknowledges that the use of Pivot Peak Performance facilities and services, and participation in Pivot Peak Performance programs, may involve inherent danger and risk, including, without limitation, the risk of physical illness or injury, death or property damage THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR, AND RISK OF ILLNESS, BODILY INJURY, DEATH OR PROPERTY DAMAGE to the undersigned or such participating children due to the negligence, active or passive, or otherwise while in, about or upon the premises of Pivot Peak Performance and/or while using the premises or any facilities or equipment thereon or participating in any program affiliated with Pivot Peak Performance. The undersigned acknowledges that any illness or injuries that the undersigned or such participating children contract or sustain may be compounded by tnegligent first aid or emergency response of the Releasees ad waive any claim in respect thereof. THE UNDERSIGNED further expressly agrees that the foregoing ASSUMPTION OF RISK, RELEASE AND WAIVER OF LIABILITY, AND INDEMNITY AGREEMENT is intended to be as broad and inclusive as is permitted by the laws of the State of Texas and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. I HAVE CAREFULLY READ AND VOLUNTARILY SIGN THIS ASSUMPTION OF RISK, RELEASE AND WAIVER OF LIABILITY, AND INDEMNITY AGREEMENT AND FURTHER AGREE THAT NO ORAL REPRESENTATIONS, STATEMENTS OR INDUCEMENT APART FROM THE FOREGOING WRITTEN AGREEMENT HAVE BEEN MADE. I AM AWARE THAT BY AGREEING TO THIS AGREEMENT I AM GIVING UP VALUABLE LEGAL RIGHTS, INCLUDING THE RIGHT TO RECOVER DAMAGES FROM BOLES FAMILY, LLC dba PIVOT PEAK PERFORMANCE IN CASE OF ILLNESS, INJURY, DEATH OR PROPERTY LOSS OR DAMAGE, INCLUDING, FOR THE AVOIDANCE OF DOUBT AND WITHOUT LIMITATION, EXPOSURE TO COVID-19 AT ANY PIVOT PEAK PERFORMANCE FACILITY OR PROGRAM AND ANY ILLNESS, INJURY OR DEATH RESULTING THEREFROM. I UNDERSTAND THAT THIS DOCUMENT IS A PROMISE NOT TO SUE AND A RELEASE OF AND INDEMNIFICATION FOR ALL CLAIMS. IF SIGNING ON BEHALF OF A MINOR: I ALSO UNDERSTAND THAT THIS AGREEMENT IS MADE ON BEHALF OF MY MINOR CHILD(REN) AND/OR LEGAL WARDS AND I REPRESENT AND WARRANT TO PIVOT PEAK PERFORMANCE THAT I HAVE FULL AUTHORITY TO SIGN THIS AGREEMENT ON BEHALF OF SUCH MINOR(S). I have read and understand the terms of this Assumption of Risk, Release Waiver of Liability, and Indemnity Agreement and agree to its terms.