NAME
ADDRESS
PHONE
EMAIL
DOB
EMERGENCY CONTACT (NAME/PHONE/RELATION)
BOOTCAMP TIME
NUMBER OF DAYS/WEEK
RATE PHYSICAL CONDITION (1-10, 10 BEING BEST)
For League: SPORT
HOW DID YOU HEAR ABOUT US
COMMENTS?QUESTIONS?HEALTH CONCERNS
**ALL PARTICIPANTS MUST READ THE OFFICIAL LEAGUE WAIVER STATED BELOW AND SIGN**
RELEASE AND WAIVER FORM
All participants are required to assume all risk by signing this general release. I understand that the risks I assume by participating in Ladimax Sports and Fitness programs include, but are not limited to serious head and other bodily injuries. In consideration of receiving permission to participate in the Ladimax Sports and Fitness, I hereby release Ladimax Sports and Fitness and all it its officers and employees from all liability for any personal injury, death or damage of any kind of arising from or related to my participation in the Ladimax Sports and Fitness program. My decision to participate in the Ladimax Sports and Fitness is voluntarily assuming all risk or loss. Damage or injury including death, may occur through my participation in the Ladimax Sports and Fitness Program. I Understand that by signing this release and waiver, I am giving up the right for myself and/or my family or heirs to sue the Ladimax Sports and Fitness, and its officers and employees for injuries resulting from participation in the Ladimax Sports and Fitness Program.
I agree to abide by all RULES and REGULATIONS governing the Ladimax Sports and Fitness which includes any disciplinary measures, fines or suspensions levied by the LADIMAX SPORTS AND FITNESS OFFICERS. I understand that Ladimax has a zero tolerance for fighting and further understand that if I should engage in a physical altercation, I will be immediately suspended from all activity. I also understand that there are no refunds.
By Participating in a Ladimax Sports and Fitness Program, I consent to the use of my appearance and likeness to be photographed and used for print/web advertisement in reference to Ladimax Sports and Fitness.
I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND EACH AND EVERY ONE OF THE ABOVE PROVISIONS IN THIS WAIVER, RELEASE OF LIABILITY AND INDEMNIFICATION AGREEMENT AND AGREE TO ABIDE BY THEM.
Name
Signature
(to be signed prior to playing)
Date
Ladimax Sports and Fitness
17 Gramercy Place
Thornwood, NY 10594
Phone: 914-469-2319
Hours of Operation:
Mon-Fri: 5AM-9PM
Sat/Sun: 8AM-4PM
