Manatee Lagoon -- An FPL Eco-Discovery Center
Mindful Moments Health and Well-Being Classes

Use of Facility and Equipment Informed Consent Form

I am 21 years of age or older and would like to participate in the following activity taking place at Manatee Lagoon, An FPL Eco-Discovery Center (“Manatee Lagoon”), located at 100 Broadway, Riviera Beach, Florida 33404 – (please fill in name of class here): .

I understand that there are possibilities of injury or other complications, including but not limited to musculoskeletal injuries, cardiovascular trauma, neurological impairment, heart attack and even death, which may occur while working out at the Manatee Lagoon, or while participating in any fitness, wellness, or other activities at Manatee Lagoon. I hereby voluntarily assume all risks associated with my use of the facilities and equipment made available to me. I understand and acknowledge that it is my responsibility to participate prudently and not to exceed any exercise or health guidelines established for me by my physician.

I understand that use of the Manatee Lagoon, its facilities and equipment, and participation in fitness, wellness, or other activities is strictly voluntary and that I may discontinue my participation at any time. I further understand that Florida Power & Light Company (“Company”) may revoke my privileges to participate in fitness, wellness, or other activities at Manatee Lagoon at any time, at its sole discretion. During my participation in the activity listed above I agree to be bound by and obey all the rules of the Company and Manatee Lagoon’s staff in my use of the facilities and equipment.

Release of Liability

In consideration of being allowed to use the Manatee Lagoon facilities and equipment, and being allowed to participate in fitness, wellness, or other activities, I hereby release, defend, indemnify, and hold harmless the Company, Manatee Lagoon, and their directors, officers, employees, agents, shareholders, subcontractors, successors, and assigns from any and all claims, demands, actions, or causes of action whatsoever, and from any and all liability for any loss or property damage or personal injury of any kind, nature, or description, including death, that may arise or be sustained by me, during or related to my participation in the fitness, wellness, or other activities and use or intended use of Manatee Lagoon’s facilities or equipment.

I hereby represent that I have read and understood this Informed Consent and Release of Liability and acknowledge that this consent and release I being relied on by the Company and Manatee Lagoon in permitting me to participate in fitness and program activities at Manatee Lagoon, and use of its facilities and equipment. I understand that at any time I may review this Informed Consent and Release of Liability by requesting a copy from Manatee Lagoon staff.

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Participant Signature Date

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Participant Name (please print)