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.