JMISS Membership Registration Form

Member's Name*

First NameLast Name

Member's Birth Date*

MonthDayYear

Member's Current Age*

Member's Gender*

MaleFemale

Member's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Member's E-mail*

example@example.com

Member's Number*

Please select a membership option below.*

Monthly Fitness App Membership: ($19 / month)Strength and Conditioning Student Membership ($99 / month)Strength and Conditioning Membership Adult Membership ($119 / month)In-person Athlete Advancement Membership: ($99 / month)Virtual Athlete Advancement Membership ($39 / month)

Trainer / Coach that referred you

Parent/Guardian Information (If Member is a Minor)

Name

First NameLast Name

Home Number

Cell Number

E-mail

example@example.com

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Alt. Phone Number

Does the member have any allergies, chronic illness, or medical conditions? If yes, please describe.

Is the member prescribed an inhaler? If yes, please explain any instructions.

Informed Consent and Acknowledgement

1. Purpose and Scope

John Melvin Institute of Sports Science (JMISS) and its affiliates—including, but not limited to, John Melvin University, John Melvin Christian College, IACCA, and associated athletic and training programs—are dedicated to providing comprehensive sports performance, mental training, educational instruction, and health-related services.
The purpose of this informed consent is to ensure that all participants understand the nature of the programs, associated risks, and their rights and responsibilities.

2. Nature of Activities

Participation in JMISS programs may include, but is not limited to:

Physical performance assessments, conditioning, and athletic training

Biomechanical and motion analysis

Sports psychology and mental performance sessions

Educational seminars, lectures, and laboratory demonstrations

Testing and research studies for performance improvement

Media, photography, or video recording for educational or promotional purposes

3. Acknowledgement of Risk

I acknowledge that participation in athletic, fitness, or research-based activities involves inherent risks, which may include but are not limited to:

Musculoskeletal injuries such as sprains, strains, fractures, or dislocations

Cardiovascular complications or health-related incidents

Emotional or mental discomfort during performance evaluations or counseling sessions

Accidental injury due to equipment malfunction or participant error

I understand that while JMISS and its affiliates take every reasonable precaution to ensure safety, they cannot eliminate all risk of injury or adverse reaction.

4. Voluntary Participation and Right to Withdraw

Participation in JMISS programs is voluntary. I may refuse to participate or withdraw at any time without penalty or loss of benefits. If I withdraw, I understand that previously collected data or media may still be used in a de-identified or previously consented manner.

5. Confidentiality and Use of Information

All personal, medical, and performance-related information will be handled in accordance with applicable privacy laws and institutional policies.
De-identified or aggregate data may be used for:

Academic research and institutional improvement

Educational materials, publications, and professional presentations

Marketing or promotional materials, only with prior written consent

6. Media Release

I grant permission for JMISS and its affiliates to record, photograph, or film my participation for educational, research, and promotional purposes.

7. Medical Authorization

In the event of an emergency, I authorize JMISS staff or representatives to seek medical treatment deemed necessary, understanding that I am responsible for any resulting expenses.

8. Assumption of Responsibility

I certify that I am physically and mentally capable of participating in the described activities and have disclosed any known medical conditions that may affect participation. I agree to follow all staff instructions, safety protocols, and institutional policies while involved in JMISS activities.

9. Release of Liability

By signing this document, I release and hold harmless John Melvin Institute of Sports Science, its affiliates, administrators, staff, agents, partners, and sponsors from any and all claims, damages, or liabilities arising from participation, except in cases of proven gross negligence or willful misconduct.

10. Acknowledgement and Consent

I have read and fully understand the information above. I have had the opportunity to ask questions, and all questions have been answered to my satisfaction. I freely consent to participate in the activities and programs conducted by JMISS and its affiliates.

Institutional Contact:

John Melvin Institute of Sports Science (JMISS)
Email: contact@playeradvancement.com

Website: www.jmisportsscience.com

Affiliates: John Melvin University • John Melvin Christian College • IACCA, Inc.

Member's Signature*

Parent's Signature (if member is a minor)

Payment / Invoicing

Once your application has been reviewed and approved by administration, you will receive an official invoice via email. This invoice will include your membership details and payment instructions. Upon completion of payment, your membership will be activated, and you will gain full access to all benefits, resources, and services associated with your JMISS membership.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Date

Membership Registration

Member Information