Liability Waiver

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New Member Registration Name:_______________________________________ Date: _____________________ Address: _______________________________________________________________ City: _____________________ State: _______________ Zip Code: _____________ Email: __________________________________________________________________ Gender: ___________________________ Birthdate: _________________________ Cell phone: _________________________ Home Phone: _____________________ How did you hear about us? ____________________________________________ What services are you interested in? __________________________________ Emergency Contact Name: _____________________________________________ Emergency Contact Phone: ____________________________________________ Would you like a consult to go over your goals? Yes:______ No: _______ Liability waiver signed? Yes:______ No: _______ Photo taken? Yes:______ No: _______

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Liability Waiver By signing below I agree that Paradigm Sport is in no way responsible for the safekeeping of my personal belongings while I attend class/workout. I understand that classes/workouts may be physically strenuous and I voluntarily participate in them with full knowledge that there is risk of personal injury, property loss or death. I agree that neither I, my heirs, assigns or legal representatives will sue or make any other claims of any kind whatsoever against Paradigm Sport or its members for any personal injury, property damage/loss, or wrongful death, whether caused by negligence or otherwise. Name: ___________________________ Date: _________________________ Signature: ______________________________________________________ Phone Number: _________________________________________________ Emergency Contact Name: _______________________________________ Emergency Contact Phone: ______________________________________