Name *

First Name

Last Name

Phone *

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Name *

First Name

Last Name

If Under 18, Parent/Guardian Name

First Name

Last Name

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Student Waiver Agreement: In consideration of being allowed to participate, I understand and acknowledge the potentially dangerous effects of physical activities. I further understand and acknowledge that Roots Hockey Development, LLC, and it's employees or contractors recommend consulting with a physician before beginning an exercise program. I acknowledge that I have either had a physicians permission to participate or that I have decided to participate in the provided activities without the approval of my physician. I further acknowledge that Roots Hockey Development, LLC and its owners, officers, employees, instructors, and agents have no expertise in diagnosing, examining or treating medical conditions. I acknowledge that instructors may give physical, hands-on adjustments during class to ensure my safety, and I agree to notify the instructor if I do not wish to be physically adjusted. I acknowledge that Roots Hockey Development, LLC and its owners, officers, and agents are not responsible for any errors, omissions, acts, or failures to act of any party or entity conducting this activity or any other on behalf of Roots Hockey Development, LLC. I acknowledge that I am fully required to provide my own medical coverage and that Roots Hockey Development, LLC will not be liable for any expenses incurred for treatment of injuries while participating in this activity. I voluntarily assume full responsibility for any risk of loss, damage, or personal injury including death, and for any property damage that may be sustained by me as a result of my participation both known and unknown in these activities. I further agree to indemnify and hold harmless to the fullest extent permitted by law, Justin Soryal or Roots Hockey Development, LLC and its employees/contractors from any loss, liability, damage, or cost that may occur due to my participation in this activity. I agree that Roots Hockey Development, LLC is in no way responsible for the safekeeping of my personal belongings while I attend class and Roots Hockey Development, LLC is also not responsible or liable for any articles lost, stolen, or damaged in or about the studio.

I AGREE with the Terms in Section 1

I DO NOT Agree with the Terms in Section 1

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Roots Hockey Development, LLC and its employee's or independent contractors will not be held liable for injuries or complications that arise while training. By signing this form I understand that all sales are final and non-transferable. By signing this form I agree that: I have read both the Waiver Agreement, I am 18 years or older or a legal guardian of the participant. I understand and acknowledge the legal consequences of signing this document, including (a) releasing Roots Hockey Development, LLC from all liability, (b) agreeing not to sue Roots Hockey Development, LLC, (c) assuming all risks of participating in this activity, (d) acceptance of all studio policies, and (e) agreeing and consenting to pay all claims and all financial responsibilities. I certify that I have carefully read this document, and fully understand its contents. I am aware that this is a contract

I AGREE to the Terms in Section 1

I Do NOT Agree to the Terms in Section 1

Date *

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