HEALTH DECLARATION and Liability 
WAIVER AND RELEASE FORM

By signing below, I agree to accept full responsibility of my own health and risks that may occur during any in-person, outdoor or online training with Nicole Hairston and Mpowered Life and Fitness LLC.  By signing below, I agree to the following: Payment and Refunds: I acknowledge that Nicole Hairston and Mpowered Life and Fitness LLC can cancel my services at any time.  There are no refunds for any services or products rendered. Payment for monthly packages and programs will be deducted on the same date monthly that the initial payment was initiated by me. It is my responsibility to inform Nicole Hairston and Mpowered Life and Fitness LLC. of any changes to my form of payment. I must cancel my monthly payment by email notification at least 2 weeks prior to my next scheduled payment.  WAIVER & RELEASE FORM Nicole Marie Hairston and for Mpowered Life and Fitness LLC:  Because physical exercise can be strenuous and subject to risk of serious injury Nicole Hairston and Mpowered Life and Fitness LLC.  urges you to obtain a physical examination and medical clearance from a doctor before using any exercise equipment or participating in any exercise activity. Do not disregard, avoid or delay obtaining health or medical advice from your health care provider as a result of the information you have obtained from Nicole Hairston and Mpowered Life and Fitness LLC.  I agree that by participating in physical exercise or training activities, I am doing so entirely at my own risk. This includes all online, outdoor and in-person training. I  agree that I am voluntarily participating in these activities and use of the trainer’s equipment, fitness application, video conferencing platform, recommended home and/or gym equipment and exercise and/or nutrition program and assume all risks of injury, illness, disease or death. Any use of meal plan and guidance, supplements of all kinds, weight reduction products, fitness applications are done so entirely at my own risk. I should consult a physician prior to undergoing any dietary or food supplement changes. Nicole Hairston and Mpowered Life and Fitness LLC. are not responsible for illness, injury, disease, or death related to any meal, nutrition or supplement recommendations.   Nicole Hairston and Mpowered Life and Fitness LLC.  are certified nutritionists or registered dietitians. All nutrition recommendations serve as an outline for what Nicole Hairston and Mpowered Life and Fitness LLC.  believe is appropriate for me based on the information I give them, their knowledge and personal experience.  I acknowledge that I have carefully read this waiver and release and fully understand that it is a release of all liability. I expressly agree to release and discharge Nicole Marie Hairston and  Mpowered Life and Fitness LLC.  from any and all claims, legal fees or causes of action and I agree to voluntarily give up or waive any right that I may otherwise have to bring a legal action against the Nicole Marie Hairston or Mpowered Life and Fitness LLC. for personal injury, death or property damage. To the extent that statute or case law does not prohibit releases for negligence, this release is also for negligence. COVID-19 and Communicable disease: I acknowledge that training in-person places me at risk for obtaining COVID-19 or any other communicable disease. I agree that I will not participate in any physical activities with Nicole Hairston or Mpowered Life and Fitness LLC. if I have a fever, chills, cough, sore throat, loss of smell, muscle aches, diarrhea or any other signs or symptoms of COVID-19 or any other communicable disease or if I have been in contact with anyone with of COVID-19 or any other communicable disease. I release Nicole Hairston and Mpowered Life and Fitness LLC.  .  Personal Property: Nicole Marie Hairston and Mpowered Life and Fitness LLC. are also not responsible for any loss or damage of my personal property. Use in Media: I acknowledge that Nicole Hairston and Mpowered Life and Fitness LLC. may use my testimonial statements, pictures obtained during online or in-person training, videos obtained during online or in-person training, or written communication of all forms including in a fitness application, email, text message, or secondary messenger applications for business use including but not limited to social media, websites, videos for advertisement, marketing and general use. If I do not wish to have by likeness used, then I need to notify Nicole Hairston in writing. If any portion of this release from liability shall be deemed by a Court of competent jurisdiction to be invalid, then the remainder of this release from liability shall remain in full force and effect and the offending provision or provisions severed here from.  By signing this release, I acknowledge that I understand its content and that this release cannot be modified orally.

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