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Waiver & Registraion 

Because physical exercise can be strenuous and subject to risk of serious injury, Glad Life Inc, (Kelea Foundation) urges you to obtain a physical examination from a doctor before beginning any exercise or training program. You agree that by participating in these physical exercise sessions, you do so entirely at your own risk. This includes, without limitation, (a) your use of all amenities and equipment in the facility and any off sitelocation and your participation in any activity, class, program, personal training or instruction, (b) the sudden and unforeseen malfunctioning of any equipment (c) our instruction, training, supervision, or dietary recommendations. You agree that you are voluntarily participating in these activities and use of these facilities and premises and assume all risks of injury. You recognize that the instructor, coach, or mentor is not a lifeguard. You expressly agree to release and discharge your instructor from any and all claims or causes of action. This waiver and release of liability includes, without limitation, all injuries to you which may occur, regardless of negligence. If any portion of this release from liability shall be deemed by a Court of competent jurisdiction to be invalid, then the remainder of this release from liability shall remain in full force and effect and the offending provision or provisions severed here from. 

You acknowledge that you have carefully read this waiver and release and fully understand that it is a release of liability. You agree to voluntarily give up any right that you may otherwise have to bring a legal action against the instructor for negligence, or any other personal injury or property damage or loss action.

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Does your youth need any special accommodations?

Does your youth have any allergies or special medical concerns?
May we use a photo of you or your child in an of our marketing materials?
Yes
No

Shoe Size

Shirt Size
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Does your youth need any special accommodations?

Does your youth have any allergies or special medical concerns?
May we use a photo of you or your child in an of our marketing materials?
Yes
No

Shoe Size

Shirt Size
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

Does your youth need any special accommodations?

Does your youth have any allergies or special medical concerns?
May we use a photo of you or your child in an of our marketing materials?
Yes
No

Shoe Size

Shirt Size
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Does your youth need any special accommodations?

Does your youth have any allergies or special medical concerns?
May we use a photo of you or your child in an of our marketing materials?
Yes
No

Shoe Size

Shirt Size
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Does your youth need any special accommodations?

Does your youth have any allergies or special medical concerns?
May we use a photo of you or your child in an of our marketing materials?
Yes
No

Shoe Size

Shirt Size
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Does your youth need any special accommodations?

Does your youth have any allergies or special medical concerns?
May we use a photo of you or your child in an of our marketing materials?
Yes
No

Shoe Size

Shirt Size
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Does your youth need any special accommodations?

Does your youth have any allergies or special medical concerns?
May we use a photo of you or your child in an of our marketing materials?
Yes
No

Shoe Size

Shirt Size
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Does your youth need any special accommodations?

Does your youth have any allergies or special medical concerns?
May we use a photo of you or your child in an of our marketing materials?
Yes
No

Shoe Size

Shirt Size
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Does your youth need any special accommodations?

Does your youth have any allergies or special medical concerns?
May we use a photo of you or your child in an of our marketing materials?
Yes
No

Shoe Size

Shirt Size
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Does your youth need any special accommodations?

Does your youth have any allergies or special medical concerns?
May we use a photo of you or your child in an of our marketing materials?
Yes
No

Shoe Size

Shirt Size
Parent or Guardian's Email Address

Email*

Confirm Email*
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*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Does your youth need any special accommodations?

Does your youth have any allergies or special medical concerns?
May we use a photo of you or your child in an of our marketing materials?
Yes
No

Shoe Size

Shirt Size
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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