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Empowered RX Waiver

To participate in our services please fill out the following form


Empowered RX Waiver

At Empowered RX, health and safety are taken very seriously.


Please fill out the following to help us be aware of any current or past health concerns. Please read the following carefully before signing.



You are purchasing the Empowered RX Membership. We require all participants to sign a waiver AND agree to the terms above. There are no refunds. 





By purchasing any of our Programs, Products and Services (“Materials”) from Empowered RX LLC (“Company”, “we”, or “us”), you agree and consent to the following legal terms and conditions that govern your use of the Program and that form a legal agreement between you and the Company, its affiliated subsidiaries and related entities. The term “you” refers to any purchaser and/or user of any of our Programs, Products and/or Services. By using any of our Programs, Products and Services you are agreeing to the Terms of Use as they appear and are legally bound by them, whether or not you have read them. If at any time you do not agree with these Terms of Use, please do not use our Programs, Products and Services.


We reserve the right to amend or update these Terms of Use at any time with or without notice to you, and may also add new features or functionality to, or change or remove existing features or functionality from, the Service that will be subject to the Terms of Use. Any User who continues to use the Service after any changes are made will be deemed to have agreed to those changes. By accepting these Terms of Use, you acknowledge that you have read them carefully. 


These Terms of Use require that dispute between you and Company will be resolved by binding, individual arbitration on an individual basis, rather than jury trial, and limit the remedies available to you in the event of a dispute. You understand that you waive your right to participate in a class action lawsuit or class-wide-arbitration and that you are waiving certain other legal rights and you are voluntarily agreeing to do so.


By purchasing or using any of our Products, Programs or Services, you acknowledge and agree to abide by these Terms of Use as well as our DisclaimerTerms and Conditions and Privacy Policy, and any and all other Terms and Conditions that may apply. Accessing, purchasing, viewing, or using our Products, Programs or Services constitutes use of the Product, Program or Service.

Photography/Video Release:

Participants involved in any activities offered by Empowered RX may be photographed or videotaped. The undersigned hereby consents to the use of these photographs and/or videos without compensation, on the Empowered RX website or in any editorial, promotional or advertising material produced and/or published by Empowered RX.

Assumption of Risk, Release of Liability, and Hold Harmless Agreement

I , the undersigned, acknowledge that I have voluntarily elected to participate in the disciplines and activities of Empowered RX on behalf of myself or my minor.

I understand that the disciplines of Empowered RX: Nutrition, Mindset, Mentorship, Fitness, Coaching, Community (collectively referred to as “Empowered RX”), can be dangerous and involve risks of injury and death. I understand that the practices of Empowered RX may include things like self-reflection, physical fitness, diet changes and other regimens that may entail certain risks that are unpredictable. The risks of such practices involved: slips and falls; falling from equipment; twists and jolts that could result in scratches, bruises, sprains, lacerations, fractures, concussions, broken bones, muscular soreness; wrist, arm and shoulder injuries; musculoskeletal injuries including head, neck, back; injuries to internal organs; the negligence of other people; my own physical condition; and the risk of emotional and psychological injuries or physical damage associated with this activity. Traveling to and from events and training activities raises the possibility of any manner of transportation accidents. 

I agree to cease activity immediately if I feel faint, lightheaded, weak, or in pain.


I certify that I am in good physical condition and that I am aware of no physical impairments, illness, or injuries that prevent me form participating in any activities with Empowered RX. 


Empowered RX employees are highly skilled and professionally trained. They seek safety first above all else, but they are not infallible. They might be unaware of a participant’s true fitness or abilities. It is ultimately up to me and not the instructors, to discontinue activity if I feel that the environment, a physical condition, the actions of myself or others, or any other reason, prohibits my mental, emotional or physical safety.


I understand and acknowledge that my participation in Empowered RX may involve risk of serious injury or death resulting from the actions, inactions, or negligence of myself and others, the condition of the facilities, equipment, or areas where Empowered RX takes place, and/or the physically demanding nature of Empowered RX. I or my Parent or Guardian, where applicable, warrant and promise that I assume full responsibility for my conduct and safety at all times, whether or not in actual participation and/or during training with Empowered RX. 

I understand and agree that neither Empowered RX, nor any of its owners, directors, employees, participants, volunteers, sponsors, advertisers, and if applicable, owners and lessors of the premises on which the Event(s) takes place (collectively and hereinafter “Releases”) or agent may be held liable for any claims or causes of action, and I personally assume full responsibility for any risks or loss, property damage, stolen property or personal injury, including death, that may be sustained by me as a result of my participation in any activity at Empowered RX whether foreseeable or unforeseeable.   



I agree to use my personal medical insurance as a primary medical coverage payment if accident or injury occurs. I give full permission for myself, or, If I am signing on behalf of a minor child, for any person connected with Empowered RX to administer first aid deemed necessary, and in case of serious illness or injury, I give permission to call for medical and or surgical care for the minor or myself and to transport the minor or myself to a medical facility deemed necessary for the well being of the minor or myself. I agree to indemnify Empowered RX for any and all claims brought on my behalf or on the behalf of the named minor by any person acting on myself or my child’s behalf; I accept responsibility for all medical expenses incurred by myself or my child in connection with Empowered RX LLC. 

The participant recognizes that there is risk involved in all types of activities offered by Empowered RX and that such risks cannot be eliminated without jeopardizing the essential qualities of the activities. Therefore the participant accepts full financial responsibility for any injury that the participant may cause either to him/herself or to any other participant due to his/her negligence. Should the above mentioned parties, or anyone acting on their behalf, be required to incur attorney’s fees and costs to enforce this agreement, I agree to reimburse them for such fees and costs. I further agree to indemnify and hold harmless Empowered RX, its “Releases” and other participants from liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in activities offered by Empowered RX, at the main building, Virtually or abroad. This includes but is not limited to parks, recreational areas, playgrounds, areas adjacent to the main building, trails, and/or any other area selected for an activity by Empowered RX.


I have read the foregoing assumption of risk, and release of liability, and by signing it I acknowledge that I fully understand its terms. I have signed it freely and voluntarily without any inducement, assurance, or guarantee being made to me. I understand that by signing this form I am waiving valuable legal rights, and intend my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.

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