Brain-Based Performance and Rehabilitation


TODAY'S DATE: August 16, 2022


I understand the activities of exercise, movement, martial arts, gymnastics, ninja warrior, obstacle course training, health/performance assessments, Z-Health, brain-based,. corrective exercise, performance enhancement, sport conditioning, cardiorespiratory training, nutritional recommendations, consultation, therapeutic services, private lessons, personal training, group training, on-line coaching, training programs and other activities including training events clinics, seminars, services and practices collectively referred to as the activities, can be dangerous and involve the risks of injury and death. I understand that these risks include, but are not limited to, loss of control, use of training facilities, exercise programs, areas designated as "training grounds", and any information construed as advice.

Despite the risks involved in the activities and in consideration of being allowed to participate in the activities, I AGREE TO EXPRESSLY ASSUME ALL RISKS OF INJURY OR DEATH that might be associated with the activities and the use of the facilities of NEUROMOTIV, including, but not limited to, the use of equipment, participation in instruction, special events, and participating in the activities beyond the supervised area (collectively referred to as "use of the facilities"). Furthermore, to the fullest extent allowed by law, I AGREE NEVER TO SUE AND TO RELEASE FROM LIABILITY NEUROMOTIV, JASON BROWN, LISA K. BLUE, AND THEIR OWNERS, EMPLOYEES, AGENTS, LANDOWNERS, SPONSORS, AND ALL AFFILIATED COMPANIES, COLLECTIVELY REFERRED TO AS NEUROMOTIV, for any damage, injury, or death to me and/or my family members (if applicable) arising from participation in the sport or uses of the facilities, regardless of cause, including the negligence of NEUROMOTIV.

I UNDERSTAND THIS IS A RELEASE OF LIABILITY THAT IS VALID FOREVER. I understand that this Release of Liability will prevent me or my heirs from filing suit or making any claim for damages in the event of an injury or death To me arising out of participation in the activities or use of the facilities. Additionally, in the event I, my heirs, the user, my legal representative, or any other person acting on my behalf files a lawsuit arising out of my participation in the activities or use of the facilities, I AGREE TO DEFEND, INDEMNIFY AND HOLD HARMLESS NEUROMOTIV for any damages, attorney's fees, or costs associated with or arising out of such a lawsuit, with a complete and full understanding of this RELEASE OF LIABILITY AND EXPRESS ASSUMPTION OF RISK AGREEMENT, I nevertheless enter into this agreement freely and voluntarily and agree that it is binding upon me ,my heirs, assigns, legal representatives and any other person acting on my behalf. I also agree to indemnify NEUROMOTIV for any and all claims brought by a third party which arise from the participant's or my participation in the activities. I grant exclusive permission to NEUROMOTIV to use my name, likeness, video, and photograph, for the purpose of coaching, publicity, public relations, editorial, or other advertising purposes without restriction as to frequency or duration.

If I am signing this liability release on behalf of a minor (less than 18 years of age):

• I represent and warrant that I am the parent and or legal guardian of such minor child ("Child") and that the Child is in good health and there are no special problems associated with the care of the Child;
• I accept responsibility for all the Child's medical expenses incurred in connection with the activities or use of the facilities;
• I agree to indemnify NEUROMOTIV for any and all claims brought by the Child or any person acting on the Child's behalf; and
• I agree to indemnify NEUROMOTIV for any and all claims brought by a third-party arising in connection with the Child's participation in the activity or use of the facilities.

I understand and agree that this Agreement is severable and that if any clause is found to be invalid, the balance of the contract will remain in effect and will be a valid and enforceable. I agree that any action will be brought in a court of competent jurisdiction in the state of Colorado. Any disputes will be subject to and determined under the laws of the State of Colorado.


I Agree

Date: August 16, 2022

First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address


Confirm Email*
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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*

Parent or Guardian's Date of Birth*
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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