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JACOBSON NINJA WARRIOR PROGRAM WITH UPF PROGRAM WAIVER FORM

RELEASE OF LIABILITY

In consideration with being allowed to participate in any way in the Jacobson Ninja Warrior Program with Ultimate Performance + Fitness, its related events and activities, I, the undersigned, acknowledge, appreciate and agree that:

The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,

While best efforts will be used to keep participants safe from the COVID-19 virus, I understand that there can be no promise or guarantee that this or any other pathogen will not enter the premises, and that by the very nature of the personal interaction that takes place in the ninja warrior program environment, there is always a risk of my becoming ill with this or any other communicable disease. I am fully aware of this risk in making the decision to register for and attend this program, and I am willing to assume and accept it; and,

I KNOWINGLY AND FREELY ASSUME ALL OF THE ABOVE 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,

I willingly agree to comply with the stated and customary terms and conditions for participation.  If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the staff of the Jacobson Ninja Warrior Program immediately; and,

 

I, for myself and behalf of my heirs, assigns, personal representatives, and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS, Sid Jacobson Jewish Community Center and Ultimate Performance + Fitness, their respective officers, officials, agents and/or employees, board members, other participants, sponsoring agencies, sponsors, advertisers, and if, applicable, owners and lessors of the premises used for the activity (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY AND DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. 

I agree to disclose any physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in the Jacobson Ninja Warrior Program with Ultimate Performance + Fitness. 

Sid Jacobson Jewish Community Center and Ultimate Performance + Fitness has the right to publish photos or videos from classes, parties or events.  In addition, Sid Jacobson Jewish Community Center and Ultimate Performance + Fitness is not responsible for lost or stolen property.

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

First Participant's Name

First Name*

Last Name*

Phone*
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

Email*

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*

Phone*
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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