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CLIENT INITIAL QUESTIONNAIRE

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GENERAL PHOTOGRAPHY RELEASE AND WAIVER

I hereby:

1. Grant to Njoku Strong Downton Cleveland, LLC, including its subsidiaries, affiliates, employees, subcontractors, agents, assigns and other representatives (collectively the "Company") the absolute right in perpetuity to own, use, publish, broadcast, promote, display, and otherwise publicize my name, likeness, image, brand, and distinctive personal attributes (my "Personal Attributes”), which shall include, but not be limited to, any images, drawings, renderings, videos, film, videotape, magnetic tape, digital file or any other recorded medium depicting or alluding to me, in the Company’s publications and promotional materials, including but not limited to the Company’s print, online, in-person and video-based marketing and promotional materials (collectively, "Materials");

2. Waive any right that | may have to inspect, control, and/or approve any Materials that include my Personal Attributes, and waive any causes of action, liabilities, claims, damages, injuries, costs (including attorneys’ fees and costs) and any other legal or equitable rights, remedies, or awards that I or any of my representatives, agents, assigns, or heirs may have or have had as a result of, relating to, or arising out of the Company’s ownership, use, publication, broadcast, promotion, display or publicizing of the Materials, which include without limitation, any claim or cause of action associated with or involving the Materials such as claims of defamation, invasion of privacy, libel, slander, breach of confidentiality, and infringement;

3. Release the Company and any third parties involved in any aspect of the acquisition, creation, development, publication, broadcast, use, promotion or display of the Materials from any liabilities, claims, damages, injuries, costs (including attorneys’ fees and ·costs) and any other legal or equitable rights, remedies, or awards, whetheř asserted by any third party or by me, my representatives, agents, assigns, or heirs, which may result from, relate to, or arise out of the Company’s use, publication, broadcast, promotion, display or publicizing of the Materials, which include without limitation, any claim or cause of action associated with or involving the Materials such as claims of defamation, invasion of privacy, libel, slander, breach of confidentiality, and infringement;

4. Agree I have granted the rights set forth herein voluntarily to the Company, and understand and agree that I will not receive financial compensation of any kind associated with the acquisition, creation, development, publication, broadcast, use, promotion or display of the Materials, including any rights to ownership, royalties, residuals or other forms of remuneration involving the Materials;

5. and Agree that I have read, understand, agree with, and have had any and all questions and issues related to this Release and Waiver answered and addressed to my satisfaction and that I am aware of my right to have independent legal counsel review and advise me in relation to this Release and Wavier. I further represent that am over the age of 18 and have the necessary capacity to agree to this Release and Waiver.

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CONTRAINDICATION CERTIFICATION

By consenting to participate in Njoku Strong personal trainer-led Electro Muscular Stimulation ("EMS") training using FDA-cleared EMS equipment, body-composition equipment, and basic conventional gym equipment, I acknowledge and agree to the following:
1. If I have any symptoms, discomfort, pain, or any other negative experience during any EMS training session at Njoku Strong, I will immediately inform my Njoku Strong trainer, stop the session, and will consult my treating health care provider or a physician. If I experience pain or discomfort before or after the training session, I will cease activity until I have consulted with a physician

2. The EMS training may not be performed for the following contraindications. I consent I have not been diagnosed with or received treatment or other medical intervention or consultation for any of the following:

  • Implanted or external medical device (e.g.,cardiac pacemaker, implanted defibrillator)
  • Severe cardiovascular disease (e.g., severe heart or aortic disease)
  • Severe neurological disorder
  • Medication-controlled or medication-uncontrolled seizures or convulsions (e.g., epilepsy)
  • Severe Neuromuscular disorder (e.g., rhabdomyolysis or any disorder affecting nervous system and muscles and causes rapid breakdown in muscle structure)
  • Cancerous lesions (e.g., Breast Cancer)
  • Severe nephrological disease (e.g., chronic kidney disease)
  • Existence/tendency of internal bleeding
  • Areas of skin that are inflamed, irritated, infected, wounded, burned or edematous (e.g., swollen, new tattoos)
  • Pregnant

3. I will inform my Njoku Strong trainer if I have any of the following:

  • Metal implants – please disclose to us any such implants so we can ensure electrodes are used in a way that it is impossible for electrical current to flow through the affected area (e.g. set intensities of such channels to 0).
  • Non-metallic or other implants (e.g. ceramic or silicone implants, gynecological, hormonal implants).

4. I will not engage in any type of intensive training, including EMS training, for two days before or after participating in Njoku Strong EMS training to avoid injury.

5. I have received my treating physician’s approval to participate in EMS training if I have been diagnosed with or received treatment or other medical intervention or consultation for, any of the following:

  • Less severe cardiovascular condition (e.g. hypertonia, high blood pressure)
  • Recent surgical procedure, medical intervention or acute trauma
  • Any type of hernia (e.g. abdominal or inguinal hernia)
  • Chronic disease or fever
  • Contagious disease or an acute or chronic infections (bacterial or viral)
  • Diabetes
  • Painful, sensitive skin or skin areas lacking normal sensation
  • Menstrual cramps
  • Taking anticoagulant medication
  • Any medical treatment (e.g. drug treatment)
  • Participation in any drug or alcohol abuse treatment
  • Mental deficit (client can only use our services with guardianship)
  • Any other disease or unusual, abnormal physical condition or symptom

I certify that I have read, understand, and agree with the statements set forth above and will not participate in EMS training at FITOPIA if I have any of the above contraindications and have not received a written approval of my participation in EMS training from my physician.

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Consent To EMS Training at Njoku Strong Downtown Cleveland, LLC

  1. I have informed myself of the basics of electro-muscular stimulation ("EMS") training methods, including any and all circumstances which contraindicate (i.e., advise against the training.
  2. I voluntarily and knowingly agree to participate in and receive EMS training from Njoku Strong Downtown Cleveland, LLC (d/b/a Njoku Strong EMS) using certain equipment, materials, and space provided by Njoku Strong, as well as Ascend Fitness and Spa and EMS equipment manufactured by WiEMSPro. I understand and agree that EMS training and use of any such equipment, materials and space provided by Njoku Strong may involve certain risks to myself and my property, including, but not limited to, property theft, damage, or loss; and physical, mental, or emotional harm or injury (including electrical shock, heart attack, adverse effects on heart rhythm, stroke, neurological damage or impairment), up to and including permanent injury and death. I also understand and agree that the equipment may possibly malfunction or not reliably operate during the course of my EMS training. I agree to assume all such risks and responsibility for any liabilities, damages, losses, harms, or other injuries to myself and my property that may result from, arise out of, or relate to my participation in EMS training at Njoku Strong, whether caused in whole or in part by myself or by the actions or omissions of Njoku Strong, Ascend Fitness and Spa, WiEMSPro, any Njoku Strong trainer or their respective employees, representatives, agents and affiliates.
  3. I am fully able to participate in EMS training with respect to my current mental and physical health status and have received no communication from health care professionals advising me to not participate in EMS training. I have consulted with, or knowingly chosen not to consult with, my physician regarding my participation in EMS training.
  4. I do not have any mental or physical conditions, symptoms, impairments, or other contraindications identified in the Njoku Strong Contraindication Certification that may exclude me from participating in EMS training.
  5. I agree to abide by all Njoku Strong’s rules, policies, procedures, and instructions related to EMS training and use of all equipment, materials, and space. I further agree to follow the instructions given to me by the Njoku Strong trainer before, during and after the training.
  6. I understand and agree that statements by Njoku Strong trainers or other personnel shall not be interpreted as medical advice or intervention, or substitute thereof. I agree that I will seek out my own health care provider(s) for all health care advice.
  7. I will inform Njoku Strong, my Njoku Strong trainer, and my physician or other health care provider of any changes in my mental or physical health status that may affect my ability or eligibility to participate in EMS training.
  8. I understand and agree that any long-term risks, outcomes, effects relating to EMS training are unknown and that I have not been promised or guaranteed any specific outcome, result, or effect as a result of my participation in EMS training at Njoku Strong. I acknowledge and agree that EMS training does not, in and of itself, cause weight loss or improvements to physical condition. No information provided by the EMS training machine, including, without limitation, weight, muscle mass, body mass index, segmental lean analysis, or any other body composition or other results constitutes a representation or warranty as to the suitability or effectiveness of Njoku Strong training, the EMS equipment or the Services, or my personal health, and is not intended to diagnose, treat, cure, or prevent any disease or health status. I agree to look only to my health care provider(s) for opinions on the suitability or effectiveness of EMS training.
  9. I understand and agree that Njoku Strong is not the direct manufacturer of any EMS equipment used at Njoku Strong, and therefore has no responsibility for defects in such equipment, or any injuries up to and including death, which the equipment may cause. I agree to look solely to the manufacturer of the EMS equipment for any injuries, damages, or other risks, up to and including death, that relate to or result from any and all defects, malfunctions, or other failures of the equipment.
  10. Due to the necessity of close personal contact while putting on and removing the training suit and undergoing EMS training, I hereby consent to having a Njoku Strong trainer or other designated Njoku Strong personnel physically assist me in putting on and removing the training suit and other training equipment, which may involve them physically touching my body and engaging in close personal contact. I will immediately report any discomfort, apprehension, safety or other concerns immediately to the Njoku Strong trainer or other Njoku Strong personnel.
  11. I agree that my personal information and training data will be recorded, stored, and used by Njoku Strong, Ascend Fitness and Spa, and WiEMSPro for purposes of operating and improving their businesses, which may include the use, disclosure and access of such data by Njoku Strong, Ascend Fitness and Spa, WiEMSPro and other third parties.
  12. I agree that I will not undergo EMS training at Njoku Strong while under the influence of any drug, alcohol, or other substance whether controlled, uncontrolled, or otherwise prescribed to or purchased by me.
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RELEASE OF LIABILITY

Release – In consideration of my participation in EMS training at Njoku Strong Downtown Cleveland LLC, I hereby release Njoku Strong from all liabilities, claims, harms, injury, demands, personal injuries (including death), causes of action, debts, controversies, judgments, suits of any kind or nature, losses of any type and including but not limited to any and all damages arising out of, related to, or resulting from my presence on Njoku Strong’s premises, my participation in any training or program at Njoku Strong, the use of any equipment, materials or space at Njoku Strong, and any Released Party’s provision of any items or services (collectively, "Claims"), whether caused in whole, or in part, from the actions, omissions, negligence, or conduct of any Released Party.

Assumption of Risks and Liabilities and Covenant Not to Sue – By executing this Release, am assuming full responsibility and risk for all Claims. I hereby waive any right may have to, and further agree to not, under any circumstances, initiate any legal proceeding or demand against any Released Party, individually or in conjunction with any other party, or otherwise join or assist in the prosecution of any Claim against any Released Party related to or arising out of my presence on Njoku Strong’s premises, my participation in any training or program at Njoku Strong, the use of any equipment, materials or space at Njoku Strong, and any Released Party’s provision of any items or services. I further agree to waive all rights, including subrogation, that my insurer may have to make any claim, lawsuit, court action, or other legal proceeding or demand against any Released Party based on payments by my insurer to me or any third party on my behalf for any reason. I acknowledge that I have read and understood all of the terms contained in this Release, and that I am voluntarily giving up substantial legal rights including the right to sue the Released Parties. I represent that l have performed a full investigation as to the potential scope and value of the claims released hereby and that I enter this agreement with full knowledge thereof.

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