Parisi Speed School Inquiry Form & Waiver

CONTACT INFORMATION

Athlete's Name

First NameLast Name

Parent's Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Email

example@example.com

Athlete's Date of Birth

Date

Athlete's Age

Athlete's Grade

Athlete's Sport(s): Please check any sport(s) that you or your athlete are involved in.

Of the sport(s) you listed above, what are your 1st and 2nd favorite?

Has your son/daughter recently suffered any injuries? If yes, please explain.

What are you son's/daughter's goals?

Why do you think this is important to your child/athlete?

How did you hear about us?

STANDARD MEDICAL RELEASE: I acknowledge that I, individually, have voluntarily applied to participate in the Parisi Speed School training program, located at Gold's Gym Middletown, NY. I acknowledge the risks and the potential risks of athletic training. However, I feel that the possible benefits to me and my child are greater than the risk assumed. I am aware that although The Parisi Speed School Licensee, Gold's Gym Middletown Franchise, its subsidiaries, Parisi Speed School Franchisor, Gold's Gym Frachisor and parent companies, its officers, directors, owners and/or employees make reasonable efforts to make each athlete’s training asafe and productive experience, that there are inherent risks which occur as a result of such physical activity. I acknowledge that an athlete, when training, through no fault of his own, his trainer(s) or the facility may becomeinjured for a variety reasons that are unavoidable. I represent that I am in good health and suffer from no physical impairment, which would limit my use of The Parisi Speed School’s and Gold's Gym's facilities or instruction. I further represent that I carry full and complete medical insurance coverage. I acknowledge that the Parisi Speed School and Gold's Gym has not and will not render any medical services including medical diagnosis of my physical condition. In consideration of being permitted by The Parisi Speed School and Gold's Gym to participate its training program and to use its facilities and/or the facilities of Parisi Speed School and Gold's Gym Middletown, NY, I hereby, intending to be legally bound for myself, my heirs and assigns, executors or administrators and/orguardian of my son/my daughter/my ward specifically agree that The Parisi Speed School, Gold's Gym, its officers, employees and agents shall not be liable for any claim, demand, cause of action of any kind whatsoever for, or on account of death,personal injury, property damage or loss of any kind resulting from or related to my use of the facilities or participation in any athletic training, exercise or activity within or outside the club premises, and I agree to hold The Speed Parisi School Licensee and Gold's Gym franchise in Middletown, NY harmless from same. I hereby waive any and all claims for any and all injuries I may suffer under anycircumstances, including but not limited to those claims arising from the negligence of the Parisi Speed School Licensee or Gold's Gym Franchise, Parisi Speed School Licensor, Gold's Gym Franchisor, its employees, agents, servants, invitees, co-members, contractors, or sub-contractors, employees or otherwise.

Athlete Signature (acceptance of Standard Medical Release)

Parent Signature (required for acceptance of Standard Medical Release if athlete is under 18 years of age)

PROMOTIONAL RELEASE: In additional consideration of being permitted by The Parisi Speed School and Gold's Gym to participate in its training program and
to use its facilities, I hereby permit The Parisi Speed School and Gold's Gym to use my name, image, photo(s), videos, and likeness for promotional purposes limited to its athletic training programs and facilities. The Parisi Speed School’s and Gold's Gym's promotional mediums include but are not limited to print, radio, video, television, social media, and the Internet. I acknowledge that I have read this release and waiver and fully understood its contents. I have been fully and completely advised of the potential dangers incidental to engaging in the activity and instruction of athlete training and I am fully aware of the legal consequences of signing this release. I voluntarily agree to the terms and conditions stated above.

Athlete Signature (acceptance of Promotional Release)

Parent Signature (required for acceptance of Promotional Release if athlete is under 18 years of age)

Date

INQUIRY FORM & WAIVER