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Leap, LLC
4037 East Grand, Suite C, Laramie WY 82070

Athlete Registration

General Waiver
LEAP

PLEASE NOTE: This waiver of Liability, Release, Acknowledgement of Risk, and Indemnification Agreement (“Waiver Agreement”) is intended to be, and is, legally binding.

If any aspect of this Waiver Agreement requires clarification, have a LEAP employee fully explain it before signing. By signing the LEAP, “Client Registration” you are agreeing to all terms set forth in this Waiver Agreement. You and/or the person on whose behalf you are signing, are waiving the right to bring any type of action, whether in court or otherwise, to recover compensation or obtain any other remedy for any personal injuries, damages to property, any accident or incident of any type, or death, arising out of or related to your use of LEAP LLC, its facilities, grounds, climbing walls, exercise areas, classes, equipment, whether the use is supervised or unsupervised. While LEAP LLC offers these activities in a controlled environment, there is still an assumed risk of injury to persons using LEAP LLC. In agreeing to this Waiver Agreement, I hereby acknowledge, understand, and agree on my behalf, and upon behalf of the person for whom I am signing, that the use of LEAP, its facilities, equipment, climbing walls, classes and/or participating in activities sponsored by LEAP have inherent risks. These risks include, but are not limited to, any injury of damage resulting from:

Negligence of employees, volunteer assistants, independent contractors of LEAP LLC. Negligent misuse of the facility, climbing walls, or equipment of LEAP; falling off or impacting against the climbing walls, impact surface, floors, or anything else; rope abrasion, entanglement or other activities occurring on the premises; cuts or abrasions resulting from any cause whatsoever; failure of the climbing walls or equipment, whether inside or outside; personal health problems, whether mental or physical; negligence of other climbers, visitors, or observers or persons who may be present in or around the climbing area or facility; and/or negligence or lack of adequate training of any person(s) who seek to assist with medical or other help either before or after any injury or damage may occur.

4037 East Grand Ave. Suite C Laramie Wyoming 82070 307-417-0408 & www.leapwyo.com

LEAP LLC

AGREEMENT AND RELEASE OF LIABILITY

1. In consideration of being allowed to participate in the activities and programs of LEAP LLC and to use its facilities, equipment and machinery in addition to the payment of any fee or charge, I, for myself, my heirs and assigns, hereby waive, release, and forever discharge LEAP LLC and their officers, agents, employees, representatives, executors and all others from any and all, responsibilities or liability from injuries or damages resulting from my participation in any activities or my use of equipment, classes, climbing walls or machinery in the above mentioned activities. I do hereby release all of those mentioned and any others acting upon their behalf from any responsibility or liability for any injury or damage to myself, including those caused by the negligent act or omission of any of those mentioned or others acting on their behalf or in any way arising out of or connected with my participation in any activities of LEAP LLC or the use of any equipment at LEAP LLC.

2. I understand and am aware that, fitness, and climbing including the use of the equipment, are all potentially hazardous activities. I also understand that fitness activities involve a risk of injury or even death, and that I am voluntarily participating in these activities and using equipment and machinery with knowledge of the dangers involved. I hereby agree to expressly assume and accept any and all risks of injury or death I further agree that I shall not attempt any exercise or activity I cannot perform or with which I am unfamiliar.

3. I do hereby declare myself to be physically sound and suffering from no condition, impairment, disease, infirmity, or other illness that would prevent my participation or use of equipment, climbing wall or machinery except as herein stated. I acknowledge that I have either had a physical examination and been given my physician’s permission to participate, or that I have decided to participate, in the activity of, fitness, and climbing and the use of the equipment, climbing wall and machinery without the approval of my physician and do hereby assume all responsibility for my participation and activities, and utilization of equipment and machinery in my activities.

Today's Date: November 25, 2020

First Participant's Name

First Name*

Last Name*

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

PRE-EXISTING CONDITIONS/INJURIES
PLEASE TELL US HOW YOU FOUND OUT ABOUT LEAP?*
Photo /Video Release: I hereby agree permission for images of my child, captured during regular and special activities through video, camera and digital camera to be used solely for the purposes of LEAP LLC promotional material, publications and web site,and waive any rights of compensation or ownership thereto. Last names of minors will not be given or posted on the web site.*
No
Yes
First Participant's Signature*
Second Participant's Name

First Name*

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

PRE-EXISTING CONDITIONS/INJURIES
PLEASE TELL US HOW YOU FOUND OUT ABOUT LEAP?*
Photo /Video Release: I hereby agree permission for images of my child, captured during regular and special activities through video, camera and digital camera to be used solely for the purposes of LEAP LLC promotional material, publications and web site,and waive any rights of compensation or ownership thereto. Last names of minors will not be given or posted on the web site.*
No
Yes
Third Participant's Name

First Name*

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

PRE-EXISTING CONDITIONS/INJURIES
PLEASE TELL US HOW YOU FOUND OUT ABOUT LEAP?*
Photo /Video Release: I hereby agree permission for images of my child, captured during regular and special activities through video, camera and digital camera to be used solely for the purposes of LEAP LLC promotional material, publications and web site,and waive any rights of compensation or ownership thereto. Last names of minors will not be given or posted on the web site.*
No
Yes
Fourth Participant's Name

First Name*

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

PRE-EXISTING CONDITIONS/INJURIES
PLEASE TELL US HOW YOU FOUND OUT ABOUT LEAP?*
Photo /Video Release: I hereby agree permission for images of my child, captured during regular and special activities through video, camera and digital camera to be used solely for the purposes of LEAP LLC promotional material, publications and web site,and waive any rights of compensation or ownership thereto. Last names of minors will not be given or posted on the web site.*
No
Yes
Fifth Participant's Name

First Name*

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

PRE-EXISTING CONDITIONS/INJURIES
PLEASE TELL US HOW YOU FOUND OUT ABOUT LEAP?*
Photo /Video Release: I hereby agree permission for images of my child, captured during regular and special activities through video, camera and digital camera to be used solely for the purposes of LEAP LLC promotional material, publications and web site,and waive any rights of compensation or ownership thereto. Last names of minors will not be given or posted on the web site.*
No
Yes
Sixth Participant's Name

First Name*

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

PRE-EXISTING CONDITIONS/INJURIES
PLEASE TELL US HOW YOU FOUND OUT ABOUT LEAP?*
Photo /Video Release: I hereby agree permission for images of my child, captured during regular and special activities through video, camera and digital camera to be used solely for the purposes of LEAP LLC promotional material, publications and web site,and waive any rights of compensation or ownership thereto. Last names of minors will not be given or posted on the web site.*
No
Yes
Seventh Participant's Name

First Name*

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

PRE-EXISTING CONDITIONS/INJURIES
PLEASE TELL US HOW YOU FOUND OUT ABOUT LEAP?*
Photo /Video Release: I hereby agree permission for images of my child, captured during regular and special activities through video, camera and digital camera to be used solely for the purposes of LEAP LLC promotional material, publications and web site,and waive any rights of compensation or ownership thereto. Last names of minors will not be given or posted on the web site.*
No
Yes
Eighth Participant's Name

First Name*

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

PRE-EXISTING CONDITIONS/INJURIES
PLEASE TELL US HOW YOU FOUND OUT ABOUT LEAP?*
Photo /Video Release: I hereby agree permission for images of my child, captured during regular and special activities through video, camera and digital camera to be used solely for the purposes of LEAP LLC promotional material, publications and web site,and waive any rights of compensation or ownership thereto. Last names of minors will not be given or posted on the web site.*
No
Yes
Ninth Participant's Name

First Name*

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

PRE-EXISTING CONDITIONS/INJURIES
PLEASE TELL US HOW YOU FOUND OUT ABOUT LEAP?*
Photo /Video Release: I hereby agree permission for images of my child, captured during regular and special activities through video, camera and digital camera to be used solely for the purposes of LEAP LLC promotional material, publications and web site,and waive any rights of compensation or ownership thereto. Last names of minors will not be given or posted on the web site.*
No
Yes
Tenth Participant's Name

First Name*

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

PRE-EXISTING CONDITIONS/INJURIES
PLEASE TELL US HOW YOU FOUND OUT ABOUT LEAP?*
Photo /Video Release: I hereby agree permission for images of my child, captured during regular and special activities through video, camera and digital camera to be used solely for the purposes of LEAP LLC promotional material, publications and web site,and waive any rights of compensation or ownership thereto. Last names of minors will not be given or posted on the web site.*
No
Yes
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*
In consideration of having LEAP LLC allow my client who is over the age of 18 to participate in the activities and programs of LEAP LLC, including but not limited to LEAP, Climbing and use of the climbing wall and any other equipment, I hereby client heirs, executors, administrators, and or assigns, waive and release any and all rights and claims of any nature as the client may have against LEAP LLC, its officers, employees, agents, chapters, assignees, licensees, and cooperating entities, their representatives, heirs, executors, administrators, successors, and assigns for and against any and all injuries or damages of any nature client may suffer while taking part in any activities connected with LEAP LLC. This release and consent shall be binding upon my clients heirs, executors, administrators, and/or assigns.
Parent or Guardian's Name

First Name*

Last Name*

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

PRE-EXISTING CONDITIONS/INJURIES
PLEASE TELL US HOW YOU FOUND OUT ABOUT LEAP?*
Photo /Video Release: I hereby agree permission for images of my child, captured during regular and special activities through video, camera and digital camera to be used solely for the purposes of LEAP LLC promotional material, publications and web site,and waive any rights of compensation or ownership thereto. Last names of minors will not be given or posted on the web site.*
No
Yes
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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