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The Program Leadership LLC dba The Program LLC

Waiver and Release from Liability

I understand that participating in the physical exercises, training and activities (the “Activities”) put on by The Program LLC (“The Program”) are potentially hazardous activities and that there are risks of injury associated with participating in the Activities. I hereby acknowledge that as a participant in the Activities, I am participating at my own risk. By signing this Waiver and Release From Liability, I understand that I personally assume all of these risks and that I feel I am physically, mentally, and medically capable and properly trained to participate in the Activities. I understand that a condition of my participation in the Activities is my agreement to knowingly and willingly sign this Waiver, and I agree to assume full responsibility for any risks, damages or injuries, known or unknown, which I might incur as the result of such participation. I, on behalf of myself, my executors, administrators, heirs and assigns, hereby agree to hold harmless The Program and its heirs, successors and assigns, managers, members, employees, agents and representatives (“The Program Representatives”) from all liability of any type or nature on account of any injury, loss, claim or damage to my health, well-being or property resulting from this participation regardless of whether such injuries, losses, claims or damages are caused by The Program or The Program Representatives.

IN WITNESS WHEREOF, I have caused this Waiver and Release from Liability to be executed as of the date set forth below.

 

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
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*

Middle 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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