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The Athlete Matrix Sign up Form and Liability Waiver

The Athlete Matrix is excited to help you with strength, conditioning, and injury preventative training. Could you please fill out the questionnaire and liability form below to secure your registration. If the athlete is under 18 years of age the parent/guardian needs to fill out the questionnaire and liability form on behalf of the athlete.

By accepting these terms , I agree that I have read and understand the below waiver.

I wish to participate in the strength and conditioning program offered by The Athlete  Matrix. I understand there are risks in participating in a program of strenuous exercise. I  have been examined by a physician of my choice in the last (60) days and have obtained  his/her approval. No change has occurred in my physical condition since the date of  approval. If a physician has not examined me, I agree to see a physician within (60) days  set forth below to obtain his/her approval for my participation in a strength and  conditioning program. 

I agree that The Athlete Matrix shall not be liable or responsible for any injuries to me  resulting from my participation in a strength and conditioning program. I release and  discharge The Athlete Matrix and its owners and employees from all claims, actions,  judgments, and the like which I or my heirs, executors, administrators or assigns may  have or claim to have as a result of any injury or other damage which may occur in  connection with my participation in a strength and conditioning program, excepting only  an injury caused by gross negligence or intentional act and such person(s). This release  shall be binding upon my heirs, executors, administrators and assigns. 

I understand that I am not obligated to perform in any activity that I do not wish to do,  and that it is my right to refuse such participation at any time during the strength and  conditioning program. I understand that should I feel lightheaded, faint, dizzy, nauseated,  or experience pain or discomfort, I am to stop activity immediately and inform a The  Athlete Matrix employee. I understand that during my strength and conditioning  program, a The Athlete Matrix employee may use touch training to correct alignment in  my posture. If I feel uncomfortable or experience any type of discomfort with touch  training, I will immediately request the the employee discontinue using the technique. 

I understand that The Athlete Matrix may photograph and/or film their members training  sessions/events for promotional purposes via marketing/website. I agree to allow them to  use these photographs and/or films of me.  I understand that during the course of my training at The Athlete Matrix, I may be asked  to run, carry weights, or perform other physical activities outside of the facility, and that I  am not obligated to perform these activities if I do not feel safe or comfortable doing so. I  agree that should I choose to undertake activities outside of the gym facility, The Athlete  Matrix is not liable or responsible for any injuries that result from my doing so. 

By registering, you also agree to receive emails from The Athlete Matrix. 

Today's Date: November 22, 2019

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information

Questionnaire


Team Name:

Sport:
First Participant's Signature*
Second Participant's Name

First Name*

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

Questionnaire


Team Name:

Sport:
Third Participant's Name

First Name*

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

Questionnaire


Team Name:

Sport:
Fourth Participant's Name

First Name*

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

Questionnaire


Team Name:

Sport:
Fifth Participant's Name

First Name*

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

Questionnaire


Team Name:

Sport:
Sixth Participant's Name

First Name*

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

Questionnaire


Team Name:

Sport:
Seventh Participant's Name

First Name*

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

Questionnaire


Team Name:

Sport:
Eighth Participant's Name

First Name*

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

Questionnaire


Team Name:

Sport:
Ninth Participant's Name

First Name*

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

Questionnaire


Team Name:

Sport:
Tenth Participant's Name

First Name*

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

Questionnaire


Team Name:

Sport:
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
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*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Questionnaire


Team Name:

Sport:
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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