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WAIVER
TRAINING SYSTEMS
First Name
Last Name
Date of Birth
Street Address
City
State
Postal / Zip code
Phone
Email Address
Emergency Name
Emergency Contact Number
Injury(s)/Surgery(s)
Health Issues & Diseases
Prescrption Medications
I or parent/guardian of the above-named member, give personal or parental/guardian consent to the rendering of necessary sports medicine services by the designated Staff and the qualified Strides ATC of which is licensed by the state of NEW YORK, and who is acting in accordance with the scope of practice under their designated state license and any other requirement imposed by New York law.
*
Yes
No
I understand and will NOT hold Strides of CNY, LLC, grounds, and facilities associated with Strides of CNY, LLC, and or any other facility responsible for any and all accidents, injuries, claims of any kind and expenses incurred as a result of participation in this program.
*
Yes
No
Do you give Strides of CNY, LLC consent to use pictures/videos of you/your child training for the sole purpose of marketing on the website and social media.
*
Yes
No
Do you give the Strides of CNY, LLC staff consent to administer testing protocols and skin fold tests* on your self and/or child? *Skin fold test is a clinical method used to estimate an individual's percentage of body fat. In which a pinch of skin fold from one of seven particular body areas - pectoral, triceps, sub scapula, mid axilla, supra iliac, abdomen, and quadriceps.
*
Yes
No
Athlete/Client listed above has been given medical clearance by a physician to participate in a vigorous strength & conditioning program provided by Strides of CNY, LLC. We/I will not hold Strides of CNY, LLC responsible for any injury/illness/death that may result in my/our athlete's /client's participation with Strides of CNY, LLC.
*
Yes
No
I declare that the info I’ve provided is accurate & complete; I accept all terms & conditions listed above.
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