GymRatz Performance Participant Info & Liability Waiver

1723 Route 17A Suite #1 Florida, NY 10921

Date *
Participant Name *
Participant Name
Participant Cell Number *
Participant Cell Number
I hereby give permission to GYMRATZ BASKETBALL PERFORMANCE, to photograph and/or videotape the participant for training and promotional purposes *
I hereby state that my participant is in good mental and physical health condition to participate in the activities provided by GymRatz Basketball Performance. I am fully aware that any activity involving athletic activity creates the possibility of illness and/or serious injury. I hereby release GymRatz Basketball Performance from liability to the above named athlete, or the person claiming through him/her, arising from illness and/or injury to the person or property of the above named at any training session or event sponsored or sanctioned by GymRatz Basketball Performance, and or travel to and from such activities. I attest that the information contained in this application is correct to the best of my knowledge. *
I understand that when I sign up for classes/memberships, there are no refunds, cancellations and/or credits. *
E-Signature Full Name *
E-Signature Full Name