KINGSTOWNE RESIDENTIAL OWNERS CORPORATION

REQUEST FOR AUTHORIZATION FOR PERSONAL TRAINER

Please deliver to:                       Director of Recreation Services

                                                Kingstowne Residential Owners Corporation

I.                    Resident Information:

            Resident’s Name:                                                                                                                    

            Resident’s Address:                                                                                                                 

            Resident’s Phone:         (H)                                                                                                      

                                                (W)                                                                                                     

            Resident’s E-Mail:                                                                                                                   

II.                 Personal Trainer Information:

A.                 Business Information

1.         Name of Business:                                                                                           

                        2.         Address:                                                                                                         
                        3.         Telephone Number:                                                                                         

4.                  Is the Business a corporation?: o Yes o No

5.                  Is the Business a Limited Liability Company? o Yes o  No

6.                  Is the Business a sole-proprietorship? o Yes o No

7.                  Is the Business a partnership or limited partnership? o  Yes o No

B.         Name of individual Personal Trainer who will be working with the Applicant: 
________________________________

C.        Attach copies of the insurance policies and certifications provided by the Personal Trainer.

D.                 Attach a signed Personal Trainer Use Agreement.

III.               Representation By the Resident 

            By my signature below, I affirm the following:

A.                 The representations made are true and complete.

B.                 I acknowledge and agree that the Personal Trainer is an independent contractor employed by me and that the Personal Trainer is not an employee, agent, contractor, associate or assign of the Kingstowne Residential Owners Corporation (“Corporation”) and that the Personal Trainer is not in any way affiliated or associated with the Corporation, its Board of Trustees, officers, members, employees or agents.

C.                 I am responsible for the actions and behavior of the Personal Trainer. 

D.                 I shall assume all risks and hazards incidental to the use of the Fitness Facilities and agree to hereby indemnify, release and hold harmless the Corporation, its Trustees, Officers, Members, Employees, WTS International, Inc. and Agents from and against all liabilities, damages, injuries, causes of action, suits, claims, and judgments of any kind whatsoever, direct or indirect, including but not limited to costs and all attorney’s fees incurred in the defense thereof, arising in connection with, incurred as a result of, or caused by my use of the Fitness Facilities and the use of the Fitness Facilities by the Personal Trainer employed by me.

E.                  I acknowledge and agree that this Agreement is binding upon my heirs, beneficiaries, successors and assigns.

            F.         I am a resident of the Kingstowne Residential Owners Corporation.

Resident’s Signature:______________________________ Date: ________________

FOR CORPORATION USE ONLY

Received:                                                                    

Application Approved:                                      

Application Disapproved:                                 

                                                                                    Signature

                                                                                    Printed Name

                                                                                    Title

                                                                                    Date

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