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RELEASE & INDEMNIFICATION AGREEMENT


WATTS AND DIESEL

7095 SOUTH BALLPARK DR

FRANKLIN, WI 53132

414-207-8171


First Athlete Name

First Name*

Last Name*

Phone*
First Athlete Date of Birth*
First Athlete Information
Primary Performance Goal*
Sports Enhancement
Sports Specific
Weight Loss
Build Muscle
Other

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

First Name*

Last Name*
Second Athlete Date of Birth*
Second Athlete Information
Primary Performance Goal*
Sports Enhancement
Sports Specific
Weight Loss
Build Muscle
Other

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

First Name*

Last Name*
Third Athlete Date of Birth*
Third Athlete Information
Primary Performance Goal*
Sports Enhancement
Sports Specific
Weight Loss
Build Muscle
Other

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

First Name*

Last Name*
Fourth Athlete Date of Birth*
Fourth Athlete Information
Primary Performance Goal*
Sports Enhancement
Sports Specific
Weight Loss
Build Muscle
Other

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

First Name*

Last Name*
Fifth Athlete Date of Birth*
Fifth Athlete Information
Primary Performance Goal*
Sports Enhancement
Sports Specific
Weight Loss
Build Muscle
Other

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

First Name*

Last Name*
Sixth Athlete Date of Birth*
Sixth Athlete Information
Primary Performance Goal*
Sports Enhancement
Sports Specific
Weight Loss
Build Muscle
Other

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

First Name*

Last Name*
Seventh Athlete Date of Birth*
Seventh Athlete Information
Primary Performance Goal*
Sports Enhancement
Sports Specific
Weight Loss
Build Muscle
Other

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

First Name*

Last Name*
Eighth Athlete Date of Birth*
Eighth Athlete Information
Primary Performance Goal*
Sports Enhancement
Sports Specific
Weight Loss
Build Muscle
Other

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

First Name*

Last Name*
Ninth Athlete Date of Birth*
Ninth Athlete Information
Primary Performance Goal*
Sports Enhancement
Sports Specific
Weight Loss
Build Muscle
Other

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

First Name*

Last Name*
Tenth Athlete Date of Birth*
Tenth Athlete Information
Primary Performance Goal*
Sports Enhancement
Sports Specific
Weight Loss
Build Muscle
Other

Are there any health concern we need to be aware of? *
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*
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

Emergency Contact's Relation to Participant
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 and Bridgewater Entertainment, LLC . 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 and Bridgewater Entertainment, LLC. 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, Bridgewater Entertainment LLC, 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 and Bridgewater Entertainment, LLC, 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 and Bridgewater Entertainment, LLC. *
I Understand and I Agree
Photo/Video Release
Participants involved in any activities offered by Bridgewater Performance and Bridgewater Entertainment, LLC 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, LLC./Bridgewater Entertainment, LLC . *
I Understand and I Agree
WAIVER/RELEASE FOR COMMUNICABLE DISEASES INCLUDING COVID-19

ASSUMPTION OF RISK / WAIVER OF LIABILITY / INDEMNIFICATION AGREEMENT     

In consideration of being allowed to voluntarily participate at Bridgewater Performance LLC and related events and activities, the undersigned acknowledges, appreciates, and agrees that:

1.  Participation includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and,

2.  I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,

3.  I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases. If, however, I observe and any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,

4.  I acknowledge that I must comply with all set procedures to reduce the spread while attending; and,

a.  I attest that:

i.   I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell; and,

ii.  I have not traveled internationally within the last 14 days; and,

iii. I have not traveled to a highly impacted area within the United States of America in the last 14 days; and,

iv. I have not traveled to a highly impacted area within the United States of America in the last 14 days; and,

v.  I have not traveled to a highly impacted area within the United States of America in the last 14 days; and,vi.  I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19; and,

5.  I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Bridgewater Performance LLC and Bridgewater Entertainment, LLC, their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event ("RELEASEES"), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IF FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

I Understand and I Agree
Massage Therapy Release of Liability
It is my choice to receive massage therapy. I am aware of the benefits and risks of massage and give my consent for massage. I understand that there is no implied or stated guarantee of success of effectiveness of individual techniques or series of appointments. I acknowledge that massage therapy is not a substitute for medical care, medical examination or diagnosis. I have stated all medical conditions that I am aware of and will inform my practitioner of any changes in my health status. I understand that my personal health information will be collected. I understand that all information that I provide will be kept confidential unless required by law. I understand and consent that my medical information may be shared by the various care providers involved in my care and treatment.
I Understand
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.


By signing below the parent or court-appointed legal guardian agrees that they are also 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
Primary Performance Goal*
Sports Enhancement
Sports Specific
Weight Loss
Build Muscle
Other

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.


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