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REGISTRATION/WAIVER

INFORMED CONSENT FOR EXERCISE PARTICIPATION
I desire to engage voluntarily in an exercise program given by the above listed sponsor, Atlas Speed Training, LLC. I understand that the activities are designed to place a gradually increasing workload on the body in order to improve overall fitness. I understand that I am responsible for monitoring my own condition throughout my workout and should any unusual symptoms occur, I will cease my participation and inform the staff of the symptoms. In signing this consent form, I affirm that I have read, accepted and understand this form in its entirety and that I understand the nature of exercise. I know that there may be risks associated with the workouts and willingly accept those possibilities. I know that it is my responsibility to ensure my own safety. I take full responsibility for my own health and safety in participating in these activities. I agree to pay any medical costs I incur.

AGREEMENT AND WAIVER / RELEASE OF LIABILITY
In consideration for being allowed to participate in this activity, which I do freely and voluntarily for my own personal benefit, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors and assign to:

  1. Waive, release and discharge from any and all liability to Atlas Speed Training LLC.,for my death, disability, personal injury, property damage, or property theft, or actions of any kind, which may hereafter, accrue to me.
  2. Indemnify and hold harmless Atlas Speed Training LLC. from any and all liabilities or claims made by other individuals or entities as a result of or relation to my participation in this activity.

Therefore, intending to be bound and as a condition of being allowed to participate in the fitness activities at Atlas Speed Training LLC.

I have freely signed this waiver on the date indicated.

Today's Date: December 9, 2022 

First Clients Name

First Name*

Last Name*

Phone*
First Clients Date of Birth*
I certify that I am 18 years of age or older
First Clients Information

PROGRAM

SPORT PLAYED *
First Clients Signature*
Second Clients Name

First Name*

Last Name*
Second Clients Date of Birth*
Second Clients Information

PROGRAM

SPORT PLAYED *
Third Clients Name

First Name*

Last Name*
Third Clients Date of Birth*
Third Clients Information

PROGRAM

SPORT PLAYED *
Fourth Clients Name

First Name*

Last Name*
Fourth Clients Date of Birth*
Fourth Clients Information

PROGRAM

SPORT PLAYED *
Fifth Clients Name

First Name*

Last Name*
Fifth Clients Date of Birth*
Fifth Clients Information

PROGRAM

SPORT PLAYED *
Sixth Clients Name

First Name*

Last Name*
Sixth Clients Date of Birth*
Sixth Clients Information

PROGRAM

SPORT PLAYED *
Seventh Clients Name

First Name*

Last Name*
Seventh Clients Date of Birth*
Seventh Clients Information

PROGRAM

SPORT PLAYED *
Eighth Clients Name

First Name*

Last Name*
Eighth Clients Date of Birth*
Eighth Clients Information

PROGRAM

SPORT PLAYED *
Ninth Clients Name

First Name*

Last Name*
Ninth Clients Date of Birth*
Ninth Clients Information

PROGRAM

SPORT PLAYED *
Tenth Clients Name

First Name*

Last Name*
Tenth Clients Date of Birth*
Tenth Clients Information

PROGRAM

SPORT PLAYED *
Clients 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*
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*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

PROGRAM

SPORT PLAYED *
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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