Loading...

 

RELEASE & INDEMNIFICATION AGREEMENT

BRIDGEWATER PERFORMANCE 

6542 S. LOVERS LANE

FRANKLIN, WI 53132

414-209-8044

First Athlete Name

First Name*

Middle Name

Last Name*

Phone*
First Athlete Date of Birth*
First Athlete Information
Primary Performance Goal*
Sports Enhancement
Sports Specific
Weight Loss
Build Muscle
Other
Style of workout interested in *
1 on 1
Group Class
How did you hear about Bridgewater Performance?*

Are there any health concern we need to be aware of? *
First Athlete Signature*
Second Athlete Name

First Name*

Middle Name

Last Name*
Second Athlete Date of Birth*
Second Athlete Information
Primary Performance Goal*
Sports Enhancement
Sports Specific
Weight Loss
Build Muscle
Other
Style of workout interested in *
1 on 1
Group Class
How did you hear about Bridgewater Performance?*

Are there any health concern we need to be aware of? *
Third Athlete Name

First Name*

Middle Name

Last Name*
Third Athlete Date of Birth*
Third Athlete Information
Primary Performance Goal*
Sports Enhancement
Sports Specific
Weight Loss
Build Muscle
Other
Style of workout interested in *
1 on 1
Group Class
How did you hear about Bridgewater Performance?*

Are there any health concern we need to be aware of? *
Fourth Athlete Name

First Name*

Middle Name

Last Name*
Fourth Athlete Date of Birth*
Fourth Athlete Information
Primary Performance Goal*
Sports Enhancement
Sports Specific
Weight Loss
Build Muscle
Other
Style of workout interested in *
1 on 1
Group Class
How did you hear about Bridgewater Performance?*

Are there any health concern we need to be aware of? *
Fifth Athlete Name

First Name*

Middle Name

Last Name*
Fifth Athlete Date of Birth*
Fifth Athlete Information
Primary Performance Goal*
Sports Enhancement
Sports Specific
Weight Loss
Build Muscle
Other
Style of workout interested in *
1 on 1
Group Class
How did you hear about Bridgewater Performance?*

Are there any health concern we need to be aware of? *
Sixth Athlete Name

First Name*

Middle Name

Last Name*
Sixth Athlete Date of Birth*
Sixth Athlete Information
Primary Performance Goal*
Sports Enhancement
Sports Specific
Weight Loss
Build Muscle
Other
Style of workout interested in *
1 on 1
Group Class
How did you hear about Bridgewater Performance?*

Are there any health concern we need to be aware of? *
Seventh Athlete Name

First Name*

Middle Name

Last Name*
Seventh Athlete Date of Birth*
Seventh Athlete Information
Primary Performance Goal*
Sports Enhancement
Sports Specific
Weight Loss
Build Muscle
Other
Style of workout interested in *
1 on 1
Group Class
How did you hear about Bridgewater Performance?*

Are there any health concern we need to be aware of? *
Eighth Athlete Name

First Name*

Middle Name

Last Name*
Eighth Athlete Date of Birth*
Eighth Athlete Information
Primary Performance Goal*
Sports Enhancement
Sports Specific
Weight Loss
Build Muscle
Other
Style of workout interested in *
1 on 1
Group Class
How did you hear about Bridgewater Performance?*

Are there any health concern we need to be aware of? *
Ninth Athlete Name

First Name*

Middle Name

Last Name*
Ninth Athlete Date of Birth*
Ninth Athlete Information
Primary Performance Goal*
Sports Enhancement
Sports Specific
Weight Loss
Build Muscle
Other
Style of workout interested in *
1 on 1
Group Class
How did you hear about Bridgewater Performance?*

Are there any health concern we need to be aware of? *
Tenth Athlete Name

First Name*

Middle Name

Last Name*
Tenth Athlete Date of Birth*
Tenth Athlete Information
Primary Performance Goal*
Sports Enhancement
Sports Specific
Weight Loss
Build Muscle
Other
Style of workout interested in *
1 on 1
Group Class
How did you hear about Bridgewater Performance?*

Are there any health concern we need to be aware of? *
Athlete 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*
Waiver and Release of Liability
Express assumption of risk: I, the undersigned, am aware that there are significant risks involved in all aspects of physical training. These risks include, but are not limited to: falls which can result in serious injury or death; injury or death due to negligence on the part of myself, my training partner, or other people around me; injury or death due to improper use or failure of equipment; strains and sprains. I am aware that any of these above mentioned risks may result in serious injury or death to myself and or my partner(s). I willingly assume full responsibility for the risks that I am exposing myself to and accept full responsibility for any injury or death that may result from participation in any activity or class while at, or under direction of Bridgewater Performance . I acknowledge that I have no physical impairments, injuries, or illnesses that will endanger me or others.
I Understand and Agree
Indemnification
The participant recognizes that there is risk involved in the types of activities offered by Bridgewater Performance . Therefore the participant accepts financial responsibility for any injury that the participant may cause either to him/herself or to any other participant due to his/her negligence. Should the above mentioned parties, or anyone acting on their behalf, be required to incur attorney's fees and costs to enforce this agreement, I agree to reimburse them for such fees and costs. I further agree to indemnify and hold harmless Bridgewater Performance , their principals, agents, employees, and volunteers from liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in activities offered by Bridgewater Performance , at the main building or abroad. This includes but is not limited to parks, recreational areas, playgrounds, areas adjacent to main building, and/or any area selected for training by Bridgewater Performance .
I Understand and I Agree
Photo/Video Release
Participants involved in any activities offered by Bridgewater Performance may be photographed or videotaped during training. The undersigned hereby consents to the use of these photographs and/or videos without compensation, on the Bridgewater Performance website or in any editorial, promotional or advertising material produced and/or published by Bridgewater Performance .
I Understand and I Agree
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*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Primary Performance Goal*
Sports Enhancement
Sports Specific
Weight Loss
Build Muscle
Other
Style of workout interested in *
1 on 1
Group Class
How did you hear about Bridgewater Performance?*

Are there any health concern we need to be aware of? *
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver