The Dragons Den and Athletes Mentor LLC Release, and Assumption of Risk Form
I,____________________________________________, have volunteered to participate in a
fitness program provided to me by __The Dragons Den and Athletes Mentor llc which may
include, but may not be limited to, resistance training, aerobic or cardiovascular exercise and
the running of specific football drills. In consideration of coaches with this agreement to instruct
and train me, I do here now and forever release and discharge and hereby hold harmless
coaches and his respective agents, heirs, assigns, contractors, and employees from any and all
claims, demands, damages, rights of action or causes of action, present or future, arising out of
or connected with my participation in this or any exercise program or football tryout including
any injuries resulting there from. THIS WAIVER AND RELEASE OF LIABILITY INCLUDES, WITHOUT
LIMITATION, INJURIES WHICH MAY OCCUR AS A RESULT OF (1) EQUIPMENT BELONGING TO
The Dragons Den and Athletes Mentor llc, THAT MAY MALFUNCTION OR BREAK; (2) ANY SLIP ,
FALL OR DROPPING OF EQUIPMENT; (3) AND/OR NEGLIGENT INSTRUCTION OR SUPERVISION.
I,_______________________________________, have been informed of, understand and am
aware that any exercise program whether or not requiring the use of exercise equipment, is a
potentially hazardous activity. I also have been informed of, understand and am aware that any
exercise and/or fitness activities involve a risk of injury, as well as abnormal changes in blood
pressure, fainting, and a remote risk of heart attack, stroke, other serious disability or death,
and that I am voluntarily participating in these activities and using equipment and machinery
with full knowledge, understanding and appreciation of the dangers involved. I hereby agree to
expressly assume and accept any and all risks of injury, regardless of severity, or death. I have
been advised that an examination by a physician should be obtained by anyone prior to
commencing a fitness and/or exercise program, or initiating a substantial change in the amount
of regular physical activity performed.
If I, ______________________________________, have chosen not to obtain a physician’s
consent prior to beginning this fitness program with The Dragons Den and
Athletes Mentor llc. I hereby agree that I am doing so solely at my own risk. In any event, I
acknowledge and \agree that I assume the risks associated with any and all fitness related
activities and/or exercises/ football tryout in which I participate. Also, I understand that if
emergency transport to the nearest hospital is deemed necessary, it will be at my
________I hereby grant The Dragons Den and Athletes Mentor llc permission to use my likeness
in a photograph, video, or other digital media in any and all of its publications, including web
based publications. I understand and agree that all photos will become the property of the Dragons den and Athletes Mentor llc and will not be returned. I hereby irrevocably authorize
The Dragons Den and Athletes Mentor llc to edit, alter, copy, exhibit, publish, or distribute these
photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished
product wherein my likeness appears. Additionally, I waive any right to royalties or other
compensation arising from or related to the use of the photo.________ I ACKNOWLEDGE THAT I HAVE THOROUGHLY READ THIS FORM IN ITS ENTIRETY AND
FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY . BY SIGNING THIS DOCUMENT, I AM
WAIVING ANY RIGHT I OR MY SUCCESSORS MIGHT HAVE TO BRING A LEGAL ACTION OR ASSERT
A CLAIM AGAINST Gridiron Godz and Athletes Mentor llc FOR NEGLIGENCE OR THAT OF OUR
EMPLOYEES, AGENTS, OR CONTRACTORS. This form is an important legal document that
explains the risks you are assuming by beginning an exercise program. It is critical that you have
read and understand this document completely. If you do not understand any part of this
document, it is your ultimate responsibility to ask for clarification prior to signing it.
Participant’s Signature
__________________________________________
Date:
_______
Please print name
_____________________________________________
Parent or Guardians Signature (if participant is under age eighteen)
_________________________________________________________
Date:
_______
Please print name
___________________________________________
