Dragon Conditioning Parent/Guardian Waiver www.dragonconditioning.com Langston Cawthorne: Owner, Director (857) 472 3636 EDGE Sports Center - 191 Hartwell Road Bedford, MA 01730 As the parent or legal guardian of a participant in a Dragon Conditioning program, I hereby give my full consent and approval for my child to participate in exercise programs. I understand that there are certain risks of injury inherent in the exercise programs and I am willing to assume the full risk of injury, including death, damages or loss which I or my child may sustain as a result of participating in this program and any and all activities connected with or associated with this program. I hereby certify that my child is fully capable of participating in the Dragon Conditioning program. Name of Child: ____________________________________________________________________________ Date of Birth_______________________ Parents Name: ___________________________________________ Address:_________________________________________________________________________________ City: _______________________________ State: ________________ Zip Code: ______________________ Home Phone: _________________ Work/Cell Phone:_____________________________________________ E-mail: ____________________________________________________ Please list any physical limitations (allergies, hearing, sight, etc)_______________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Please return completed form to [email protected] Parent/Guardian Signature: _______________________________________________________ Waiver: By accepting the terms of this agreement, on behalf of yourself, your heirs, assigned insurance companies, executors, and administrators, you are acknowledging that you do hereby waive, release, and forever discharge Langston Cawthorne, Dragon Conditioning, and their respective heirs, owners, directors, officers, agents, employees, representatives, successors, and all others from any and all responsibility or liability from injuries or damages resulting from, or connected with, your participation in any of the Dragon Conditioning exercise programs.
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