BST Waiver Form Participants Age * Name of Participant * First Name Last Name School attending in the Fall * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Home Phone (###) ### #### Cell Phone (###) ### #### Email * Emergency Contact Name * Emergency Contact Cell Phone (###) ### #### Informed Consent For Exercise Participation I desire to engage voluntarily in an exercise program given by Landecker Baseball, LLC (BST) in Chatsworth, California. 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 workouts 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, accept and understand this form in its entirety and that I understand the nature of exercise. I know that there may be risks associated with fitness classes 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 the fitness class and to the extent I deem advisable, will consult a physician before participating in any of the activities. I agree to pay all reasonable costs related to the classes, including 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 assigns to: 1. Waive, release and discharge from any and all liability to Landecker Baseball, LLC (BST), their elected and appointed officials, employees, students, agents, and volunteers 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 Landecker Baseball, LLC (BST), their elected and appointed officials, employees, students, agents, and volunteers, from any and all liabilities or claims made by other individuals or entities as a result of or relating to my participation in this activity. Therefore, intending to be bound and as a condition of being allowed to participate in the Strength and Conditioning Program, I have freely signed this waiver on the date indicated. Participants Signature * Write Full Legal Name In Lieu of Signature Date * MM DD YYYY Parent/Guardian Name First Name Last Name Parent/Guardian Signature (Required if under 18 years old) Write Full Legal Name In Lieu of Signature If you have any questions... Contact: Adam Landecker Email: baseballspecifictraining@gmail.com Thank you!
