Please answer the following questions of this form. Your answers will better help me in providing quality service.
[radio* treated-for-ailments class:form-check-input use_label_element "Yes" "No"]
High Blood PressureHeart ConditionHigh CholesterolDizziness/FaintingBlood clotsDiabetes
Back Pain/tightness upper lowerShoulder painHips replacement or pain Legs/FeetSciaticaKnee surgeryNeck Pain with movementStiffArthritisSurgeries in the past 3 yearsInjuries in the past 3 years
I am applying for acceptance to t2 Coaching and associated activities, being fully aware that these activities involve risks. I accept all the risks associated with participating in t2 activities, even if they are created by the carelessness or negligence of a released party or anyone else. (“Released parties” as used in this document means t2 Coaching, its owners, officers, directors, stock-holders, managers, employees, associates, agents, representatives and assigns). Risks include physical exertion, wet and uneven surface conditions, temperature extremes, and all other potential damages associated with personal injury sustained during t2 activities. I fully release, discharge and waive any Claims I may have, now or in the future against all released parties, even if Claims are based on the carelessness or negligence of a released party or anyone else. (“Claims” as used in this document means any and all liabilities, claims, demands, legal actions, and rights of action for damages, personal injury or death that are related to or in any way connected with participation in t2 activities.). I agree not to sue released parties for Claims, even if the Claims arise from the carelessness or negligence of a released party or anyone else. I agree to indemnify (reimburse for any loss) and hold harmless each released party from any loss or liability (including any reasonable attorney’s fees they may incur) in defending any Claim made by me or anyone making a Claim on my behalf, even if the Claim is alleged to or did result from the carelessness or negligence of a released party or anyone else. I am aware that there is no obligation for any person to provide me with medical care during t2 activities. If medical care is rendered to me, I consent to that care if I am unable to give my consent for any reason at the time that the care is rendered. I am aware that it is advisable to consult a physician prior to participating in t2 activities. If I have consulted one, I have taken the physician’s advice. I understand and intend that this document act as the broadest and most inclusive assumption of risk, waiver, release of liability, agreement not to sue and indemnify as permitted by the laws of the State of Colorado. If the member is under the age of 18, the parent agrees to the following statements: as a parent or guardian of the participant, I authorize the child to participate in t2 Coaching activities. I also join in the statements and agreements made by the released parties in this document. I also agree that, in the event the participant or anyone acting on his or her behalf should make any Claims, I will provide the indemnity and hold harmless the released party set forth above.
