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Waiver of Liability 

I, (participant or parent/guardian of minor participant), understand that my participation in any exercise training program, including any exercise training program with MASE Training, LLC (“MASE”), involves risk of physical injury.

1. I acknowledge that I am in good health and, to the best of my knowledge, am capable of participating in an exercise program. I further agree to disclose any physical limitations, disabilities, ailments or impediments that may arise that may affect my ability to participate in an exercise program.

2. I hereby release MASE, its agents, independent contractors, members, partners, successors and assigns from liability for injury or illness, physical or emotional that results from participating in exercise programs sponsored by MASE. I assume all risks associated with participating in the exercise program and take full responsibility for any injuries that I may suffer and/or loss of property while participating in an exercise program with MASE. It is my expressed intent that this waiver shall bind the members of my family, heirs and assigns.

3. I acknowledge that I have carefully read this waiver and release of liability. I understand that I am waiving a legal right to bring a legal action and to assert a claim against the trainer for negligence.

4. I voluntarily agree to participate in an exercise program with MASE in accordance with these conditions.

 

Trainer Signature: EDDIE MASON     (Digital)

Date: October 4, 2023

First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information

Home Phone

Cell Phone *

Work Phone
First Participant's Signature*
Second Participant's Name

First Name*

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

Home Phone

Cell Phone *

Work Phone
Third Participant's Name

First Name*

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

Home Phone

Cell Phone *

Work Phone
Fourth Participant's Name

First Name*

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

Home Phone

Cell Phone *

Work Phone
Fifth Participant's Name

First Name*

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

Home Phone

Cell Phone *

Work Phone
Sixth Participant's Name

First Name*

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

Home Phone

Cell Phone *

Work Phone
Seventh Participant's Name

First Name*

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

Home Phone

Cell Phone *

Work Phone
Eighth Participant's Name

First Name*

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

Home Phone

Cell Phone *

Work Phone
Ninth Participant's Name

First Name*

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

Home Phone

Cell Phone *

Work Phone
Tenth Participant's Name

First Name*

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

Home Phone

Cell Phone *

Work Phone
Participant's 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

First Name*

Last Name*

Emergency Contact's Phone Number*

Emergency Contact's Relation to Participant
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*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Home Phone

Cell Phone *

Work Phone
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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