The Family Workout Experience with Antoinette B Funky

Come out and join the fitness fun

 Hennepin Community Center

24 Ludington St. Buffalo, NY 14206

6 Consecutive Saturdays 11/5, 11/12, 11/19, 11/26, 12/3, 12/10

On-site Registration: 10:30am,  Class time: 11am-12pm
Pre-Registration: See form below ↓

Ages 5-18:  FREE
Adults 19 and Up: $5 per class or $25 for all 6 Weeks!

Please complete the form below to pre-register children and adults (full 6 week session only). Payments for the 6 week session are made via PayPal.

Pre-Registration & Participation Waiver

    Participant Information

  • Group Exercise Waiver and Release

  • I have enrolled in the Move and Groove Family Fitness sessions offered by the Police Athletic League if Buffalo, Inc. and Antoinette Pickens. I recognize that the program may involve strenuous physical activity including, but not limited to, muscle strength and endurance training, cardiovascular conditioning and training, and other various fitness activities. I hereby affirm that I am in good physical condition and do not suffer from any known disability or condition which would prevent or otherwise limit my full participation in this physical program.

    In addition, I am fully aware of the risks and hazards connected with the participation in the physical fitness program including, but not limited to, physical injury or even death. I hereby elect to voluntarily participate in this program knowing that the associated physical activity may be hazardous to me and/or my children. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OR LOSS, PROPERTY DAMAGE, OR PERSONAL INJURY, INCLUDING DEATH, THAT MAY BE SUSTAINED BY ME, OR LOSS OR DAMAGE TO PROPERTY OWNED BY ME, AS A RESULT OF PARTICIPATION IN THIS PROGRAM.

    I hereby release, waive, discharge, and covenant not to sue the Police Athletic League, Inc. and/or any of its community partners, officers, servants, agents, consultants, volunteers, and/or employees from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or injury (including, but not limited to, death) that may be sustained by me, or to any children belonging to me, while participating in this program, or while on or upon the premises where the event is being conducted including, but not limited to, any claims arising under negligence.

    It is my expressed intent that this waiver and release shall bind any and all members of my family including, but not limited to, my spouse, if I am alive, and my heirs, assigns, and personal representatives, if I am deceased. It is also my expressed intent that this waiver and release shall also be deemed a full release, waiver, discharge, and covenant not to sue insofar as my aforementioned family members, heirs, assigns, and personal representatives are concerned. I hereby further agree that this waiver and release shall be constructed in accordance with the laws of the State of New York.

    Buffalo Police Athletic League requires that you certify this waiver/release form by submitting an electronic signature. To certify your form, read the text below, provide an electronic signature (type your name) and click "SUBMIT".
  • Electronic Signature

  • In signing this waiver and release, I acknowledge and represent that I have read and understand the foregoing and hereby sign it voluntarily as my own free act and deed; no oral representations, statements or inducements, apart from the foregoing written agreements have been made; and I hereby execute this waiver and release for valuable consideration, intending to be bound by the same. This waiver is good for the 6-sessions in November and December of 2016.