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AMERICAN PARKOUR COMPANY, INC. DBA APK ACADEMY

Client Information / Parkour and Freerunning Consent Form 

Today's Date: July 16, 2019

AMERICAN PARKOUR COMPANY, INC. DBA APK ACADEMY 

Parkour and Freerunning Waiver and Release

I wish to receive training and instruction in the sport of Parkour (the "Training") from APK Academy (together with all of its shareholders, directors, officers, employees, agents, representatives, servants, assigns and successors, "APK Academy").

I ACKNOWLEDGE THAT THE TRAINING INVOLVES HIGH INTENSITY EXERCISES INCLUDING BUT NOT LIMITED TO; LIFTING WEIGHTS, BODYWEIGHT EXERCISES, RUNNING AND SIMILAR MOVEMENTS BOTH INDOORS AND OUTDOORS IN HEAVILY-CONGESTED URBAN AREAS, CONTACT WITH OBSTACLES AND OTHER HUMANS, AND THAT ACCORDINGLY SERIOUS INJURY AND EVEN DEATH MAY RESULT FROM PARTICIPATING IN THE TRAINING. I KNOW AND UNDERSTAND THE SCOPE, NATURE, AND EXTENT OF THE RISKS INVOLVED IN PARTICIPATING IN THE TRAINING AND VOLUNTARILY AND FREELY CHOOSE TO INCUR ANY AND ALL SUCH RISKS AND DANGERS, EVEN IF ANY SUCH RISK OR DANGER ARISES FROM THE ACTIONS OR INACTIONS OF APK ACADEMY.

I represent that I am in good physical condition and am otherwise physically capable of participating in the Training, and that I do not suffer from any condition which may endanger my safety or the safety of anyone else participating in the Training, including but not limited to pregnancy, epilepsy, hypertension, cardiovascular disease, skeletal or joint or ligament problem or condition, asthma, emphysema, or chronic obstructive pulmonary disease.

I, ON MY OWN BEHALF, AND ON BEHALF OF MY EXECUTORS, PAST AND PRESENT HEIRS, ASSIGNS, AND PERSONAL AND LEGAL REPRESENTATIVES DO HEREBY WAIVE, RELEASE AND FOREVER DISCHARGE APK ACADEMY, OF AND FROM ANY AND ALL CLAIMS, DEBTS, DEMANDS, RIGHTS, LIABILITIES, CAUSES OF ACTION, LOSSES, DAMAGES, COSTS OR EXPENSES, INCLUDING REASONABLE ATTORNEYS' FEES (COLLECTIVELY, "CLAIMS") OF WHATSOEVER KIND AND NATURE, ARISING FROM, RESULTING FROM, OR RELATING IN ANY WAY TO THE TRAINING. I agree and covenant not to sue or bring any Claims against APK Academy with respect to any matters arising out of or relating to the Training. In the event that I or anyone else on my behalf institutes any such action, that Claim shall be dismissed upon presentation of this Waiver and Release and I will reimburse APK Academy for all legal fees and expenses incurred in defending such Claim and obtaining its dismissal.

I agree and acknowledge that my participation in the Training may be recorded in one or more medium. I authorize APK Academy to photograph, record and otherwise exploit my image, likeness and voice (together, "My Likeness") and to use, exhibit, publish and distribute written works, recordings, productions, photographs and other exploitations containing any part of My Likeness made by or on behalf of the APK Academy for any purpose and in any medium now known or hereafter developed (together, "the Materials"). I acknowledge that APK Academy will be the sole owner of all rights in and to the Materials, including all rights of copyright, for all purposes, regardless of the form or medium in which they are produced or used. APK Academy shall have the right, among other things, to edit the Materials at its discretion, to incorporate part or all of the Materials, to use, duplicate, exhibit, broadcast and distribute the Materials and to license others to do so in all media. I waive any right that I may have to inspect or approve any part of the Materials that incorporate My Likeness. I release and discharge APK Academy from, and hereby agree to indemnify, defend, and save harmless, APK Academy from any and all Claims I or any third party may have now or in the future for invasion of privacy, right of publicity, copyright infringement or other Claims arising out of the use, exploitation, reproduction, adaptation, distribution, broadcast, performance, or display of My Likeness. I acknowledge that I will not receive any monetary compensation from APK Academy for any use of My Likeness. I warrant that I am at least eighteen years of age, and have every right to enter into this Waiver and Release.

I HAVE READ THIS WAIVER AND RELEASE AND FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

First Student's Name

First Name*

Middle Name

Last Name*

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

Height: (used to calculate power output) *

Weight: (used to calculate power output) *
Current Experience Level*
Have you done a CrossFit or Primal Fitness workout before?*
No
Yes

If yes, where:

Occupation:

Training Interests / Goals

Do you have any injuries, recent illness, surgery or medical condition?
How did you hear about us?*

If Other:
First Student's Signature*
Second Student's Name

First Name*

Middle Name

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

Height: (used to calculate power output) *

Weight: (used to calculate power output) *
Current Experience Level*
Have you done a CrossFit or Primal Fitness workout before?*
No
Yes

If yes, where:

Occupation:

Training Interests / Goals

Do you have any injuries, recent illness, surgery or medical condition?
How did you hear about us?*

If Other:
Third Student's Name

First Name*

Middle Name

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

Height: (used to calculate power output) *

Weight: (used to calculate power output) *
Current Experience Level*
Have you done a CrossFit or Primal Fitness workout before?*
No
Yes

If yes, where:

Occupation:

Training Interests / Goals

Do you have any injuries, recent illness, surgery or medical condition?
How did you hear about us?*

If Other:
Fourth Student's Name

First Name*

Middle Name

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

Height: (used to calculate power output) *

Weight: (used to calculate power output) *
Current Experience Level*
Have you done a CrossFit or Primal Fitness workout before?*
No
Yes

If yes, where:

Occupation:

Training Interests / Goals

Do you have any injuries, recent illness, surgery or medical condition?
How did you hear about us?*

If Other:
Fifth Student's Name

First Name*

Middle Name

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

Height: (used to calculate power output) *

Weight: (used to calculate power output) *
Current Experience Level*
Have you done a CrossFit or Primal Fitness workout before?*
No
Yes

If yes, where:

Occupation:

Training Interests / Goals

Do you have any injuries, recent illness, surgery or medical condition?
How did you hear about us?*

If Other:
Sixth Student's Name

First Name*

Middle Name

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

Height: (used to calculate power output) *

Weight: (used to calculate power output) *
Current Experience Level*
Have you done a CrossFit or Primal Fitness workout before?*
No
Yes

If yes, where:

Occupation:

Training Interests / Goals

Do you have any injuries, recent illness, surgery or medical condition?
How did you hear about us?*

If Other:
Seventh Student's Name

First Name*

Middle Name

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

Height: (used to calculate power output) *

Weight: (used to calculate power output) *
Current Experience Level*
Have you done a CrossFit or Primal Fitness workout before?*
No
Yes

If yes, where:

Occupation:

Training Interests / Goals

Do you have any injuries, recent illness, surgery or medical condition?
How did you hear about us?*

If Other:
Eighth Student's Name

First Name*

Middle Name

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

Height: (used to calculate power output) *

Weight: (used to calculate power output) *
Current Experience Level*
Have you done a CrossFit or Primal Fitness workout before?*
No
Yes

If yes, where:

Occupation:

Training Interests / Goals

Do you have any injuries, recent illness, surgery or medical condition?
How did you hear about us?*

If Other:
Ninth Student's Name

First Name*

Middle Name

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

Height: (used to calculate power output) *

Weight: (used to calculate power output) *
Current Experience Level*
Have you done a CrossFit or Primal Fitness workout before?*
No
Yes

If yes, where:

Occupation:

Training Interests / Goals

Do you have any injuries, recent illness, surgery or medical condition?
How did you hear about us?*

If Other:
Tenth Student's Name

First Name*

Middle Name

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

Height: (used to calculate power output) *

Weight: (used to calculate power output) *
Current Experience Level*
Have you done a CrossFit or Primal Fitness workout before?*
No
Yes

If yes, where:

Occupation:

Training Interests / Goals

Do you have any injuries, recent illness, surgery or medical condition?
How did you hear about us?*

If Other:
Student'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.
In Case of Emergency (ICE)

Name (Please save on your cell phone under "ICE")

ICE Home Phone Number

ICE Mobile Phone Number

ICE Relationship
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*

Middle Name

Last Name*

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

Height: (used to calculate power output) *

Weight: (used to calculate power output) *
Current Experience Level*
Have you done a CrossFit or Primal Fitness workout before?*
No
Yes

If yes, where:

Occupation:

Training Interests / Goals

Do you have any injuries, recent illness, surgery or medical condition?
How did you hear about us?*

If Other:
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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