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REVOLUTION PARKOUR GRESHAM

ASSUMPTION OF RISK & RELEASE OF LIABILITY AGREEMENT

Today's Date: September 20, 2018

I, the undersigned, hereby acknowledge voluntary participationto take part in Revolution Parkour Gresham classes, routines, and exercises operated by Revolution Parkour Gresham and its owners, employees, representatives and/or affiliates.

I am aware that participation in the classes, routines, and exercises will require me to engage in many vigorous physical activities. I am voluntarily participating in these activities with the knowledge that there are possible risks involved including serious injury and even death. I hereby assume all risks and hazards incidental to such participation and agree to accept any and all risks of injury and/or death as a result of my participation in these routines and exercises.

I am aware that the routines, exercises, and movements taught by Revolution Parkour Gresham are based on the techniques utilized in parkour and free running, and are intended to be performed only while under the strict supervision of a trained professional. I hereby assume all risks and hazards incidental to my practice of said routines, exercises, and movements if I choose to perform or practice said routines and/or exercises and/or movements outside of class, whether or not I am under said supervision, including, but not limited to, any routine, exercise, or movement similar to or associated with parkour, free running, or anything taught or advocated by Revolution Parkour Gresham.

I grant permission to the employees and or representatives of Revolution Parkour Gresham to authorize and obtain emergency medical care from any licensed physician, hospital, or medical clinic in the event that such care is required.

I grant permission to Revolution Parkour Gresham to use my name, likeness, and photograph for the purpose of publicity, public relations, editorial, or other advertising purposes without restriction as to frequency or duration.

I have carefully read this agreement before executing it and acknowledge that I am signing this agreement voluntarily and with the full intent of releasing Revolution Parkour Gresham from any and all claims arising as a result of my participation in the classes, routines and exercises.

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
Current medical conditions?*
No
Yes

If YES, please explain:

How did you hear about us? *

Zip code:
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
Current medical conditions?*
No
Yes

If YES, please explain:

How did you hear about us? *

Zip code:
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
Current medical conditions?*
No
Yes

If YES, please explain:

How did you hear about us? *

Zip code:
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Current medical conditions?*
No
Yes

If YES, please explain:

How did you hear about us? *

Zip code:
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Current medical conditions?*
No
Yes

If YES, please explain:

How did you hear about us? *

Zip code:
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Current medical conditions?*
No
Yes

If YES, please explain:

How did you hear about us? *

Zip code:
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Current medical conditions?*
No
Yes

If YES, please explain:

How did you hear about us? *

Zip code:
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Current medical conditions?*
No
Yes

If YES, please explain:

How did you hear about us? *

Zip code:
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Current medical conditions?*
No
Yes

If YES, please explain:

How did you hear about us? *

Zip code:
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Current medical conditions?*
No
Yes

If YES, please explain:

How did you hear about us? *

Zip code:
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Current medical conditions?*
No
Yes

If YES, please explain:

How did you hear about us? *

Zip code:
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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