Colacurcio Wellness LLC
(DBA: Vitality Modern Wellness)

Membership Waiver and Release of Liability for Individuals at Higher Risk of Heart Attack or Stroke


I, the undersigned, understand that engaging in physical activities at Colacurcio Wellness LLC (DBA: Vitality Modern Wellness) involves certain risks, especially for individuals with a higher risk of heart attack or stroke. These risks may include but are not limited to cardiovascular stress, elevated heart rate, and potential exacerbation of pre-existing health conditions. By voluntarily participating in activities at Colacurcio Wellness LLC (DBA: Vitality Modern Wellness), I acknowledge and accept the following:

  1. I am aware of my heightened risk of heart attack or stroke, and I have consulted with my healthcare provider to determine my suitability for physical activities.
  2. NAME OF CARDIOLOGIST MD / OFFICE, ETC?
  3. I am responsible for informing the club owner and director:  Steve Colacurcio DC either in person or via text, email or telephone: of any changes in my health status or if I experience any discomfort, pain, or unusual symptoms during or after activities.
  4. I release Colacurcio Wellness LLC (DBA: Vitality Modern Wellness) its employees, agents, and representatives from any liability for injuries, damages, or medical conditions that may arise as a result of my participation, taking into account my heightened risk.
  5. I understand the importance of obtaining medical clearance before engaging in physical activities and have sought such clearance from my healthcare provider.
  6. I agree to comply with all safety guidelines and instructions provided by Colacurcio Wellness LLC (DBA: Vitality Modern Wellness) and staff to minimize risks during my participation.


I have read and understood the terms of this waiver, and I willingly assume the associated risks.
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Signature Certificate
Document name: Waiver - Individuals at Higher Risk of Heart Attack or Stroke
lock iconUnique Document ID: 25851d87b742ac6036fe862bfab3ed19742d45cc
Timestamp Audit
November 20, 2023 4:18 pm ESTWaiver - Individuals at Higher Risk of Heart Attack or Stroke Uploaded by Steve Colacurcio - scolacurcio@icloud.com IP 173.70.19.34
December 7, 2023 1:41 pm EST Document owner eli@insomniagraphix.com has handed over this document to scolacurcio@icloud.com 2023-12-07 13:41:24 - 198.232.120.235