Waiver

Rooted Loveland, LLC, New Participant Form

First Name *

Last Name *

Email Address *

Street Address

Apartment, suite, etc

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DOB *

Phone Number *

Agreement of Release and Waiver of Liability

I, {name-1-first-name}{name-1-last-name}, voluntarily agree to participate in Rooted Loveland classes. I recognize that this work involves physical activity and movement, which may carry some natural risks. I am responsible for my own experience and my own safety. I also understand that I am responsible for continuing to monitor my physical limits. I represent and warrant that I have no medical conditions that would endanger me in any way or prevent my participation in classes.

I, my heirs, and legal representatives forever release, waive, discharge and covenant not to sue Rooted Loveland, LLC, landlord, agents or any associates for any claim I may have for injury, or damages that I may sustain as a result of my participation in Rooted Loveland classes. I have read the release and waiver of liability and fully understand its consent. I voluntarily agree to the terms and conditions stated above.

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As legal guardian of *I consent to the above listed terms and conditions

Signature of Participant *

Signature *

Today's Date *

Emergency Contact Info

First Name *

Last Name

Phone *

Relationship *