This form must be filled out by all participants. Or you may download the form to fill out, print and bring it in to the Sports Life Training Center. Participant #1First Name*Last Name*Birth Date* MM DD YYYY Participant #2First NameLast NameBirth Date MM DD YYYY Participant #3First NameLast NameBirth Date MM DD YYYY Participant #4First NameLast NameBirth Date MM DD YYYY In consideration for gaining access to 10810 US Hwy 19 N, Clearwater, FL 33764 (the “Location”) and engaging in the services of Sports Life Training or any other location within the state of Florida, d/b/a SLTC or Sports Life Training Center, their agents, owners, officers, directors, representatives, assigns, affiliates, volunteers, participants, employees, insurers, and all other persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as “SLTC”), I on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representatives, estate, and insurers, agree as follows: * IF THERE ARE ANY DISPUTES REGARDING THIS AGREEMENT, I ON BEHALF OF MYSELF AND/OR MY CHILD(REN) AGREE THAT THE DISPUTE WILL BE DETERMINED BY BINDING ARBITRATION TO BE ADMINISTERED BY JAMS (Judicial Arbitration and Mediation Services) PURSUANT TO ITS COMPREHENSIVE ARBITRATION RULES AND PROCEDURES. I FURTHER AGREE THAT THE ARBITRATION WILL TAKE PLACE SOLELY IN THE STATE OF FLORIDA AND THAT THE SUBSTANTIVE LAW OF FLORIDA SHALL APPLY. I UNDERSTAND THAT BY SIGNING THIS AGREEMENT, I HEREBY WAIVE ANY RIGHT I AND/OR MY CHILD(REN) MAY HAVE TO A TRIAL. I AGREE THAT SUCH DISPUTE SHALL BE BROUGHT WITHIN ONE YEAR OF THE DATE OF THIS AGREEMENT.** In consideration of SLTC allowing my participation in sports performance, team training’s, games or activities, I FOR MYSELF AND ON BEHALF OF MY CHILD(REN) AND/OR LEGAL WARD, HEIRS, ADMINISTRATORS, PERSONAL REPRESENTATIVES, OR ASSIGNS, DO AGREE TO HOLD HARMLESS, RELEASE AND DISCHARGE SLTC OF AND FROM ALL CLAIM’S, DEMANDS, CAUSES OF ACTION, AND LEGAL LIABILITY, WHETHER THE SAME BE KNOWN OR UNKNOWN, ANTICIPATED OR UNANTICIPATED, DUE TO SLTC ORDINARY NEGLIGENCE and I, for myself and on behalf of my child(ren) and/or legal ward, heirs, administrators, personal representatives, or any assigns, further agree that except in the event of SLTC’s gross negligence and willful and wanton misconduct, I shall not bring any claims, demands, legal actions and causes of action, against SLTC for any economic and/or non-economic losses due to bodily injury, death, property damage sustained by me and/or my minor child(ren) that are in any associated with SLTC sports performance, teams training, games or activities. Should SLTC or anyone acting on their behalf be required to incur attorney’s fees and costs to enforce this agreement, I for myself and on behalf of my child(ren) and/or legal ward, heirs, administrators, personal representatives or assigns, agree to indemnify and hold them harmless for all such fees and costs. ** I acknowledge that my participation in SLTC sports performance, team training’s, games or activities, entails known and unanticipated risks that could result in physical or emotional injury including, but not limited to broken bones, sprained or torn ligaments, paralysis, death or other bodily injury or property damage to myself my child(ren) or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity. I expressly agree and promise to accept and assume all of the risks, known and unknown, existing in this activity. My and/or my child(ren)’s participation in this activity is purely voluntary and I elect to participate or allow my children to participate with full knowledge of the potential risks, both known and unknown. If I and/or my child(ren) are injured, I acknowledge that I or my child(ren) may require medical assistance, which I acknowledge will be at my own expense or the expense of my personal insurer(s). I hereby represent and affirm that I have adequate and appropriate insurance to provide coverage for such medical expense. I UNDERSTAND AND AGREE THAT SLTC WILL NOT PAY FOR ANY COST OR EXPENSES INCURRED BY ME IF I AND/OR MY CHILD ARE INJURED UNLESS SUCH INJURY WAS CAUSED BY GREATER THAN ORDINARY NEGLIGENCE OF SLTC. ** I certify that I and/or my child(ren) are physically able to participate in all activities at the location without aid or assistance. I further certify that I am willing to assume the risk of any medical or physical condition that I and/or my child may have. I acknowledge that I have read the rules, (“SLTC Rules”) governing my and /or my child(ren) participation in any activity at the location. I certify that I have explained the “SLTC Rules” to the child(ren) listed in this waiver. I understand that the “SLTC Rules” have been implemented for the safety of all guests at the location. Including myself and/or my child(ren). I acknowledge that failure to follow the rules could result in the expulsion of myself and/or my child(ren) from the location. ** I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect. If, despite the representations made in this agreement, I or anyone on behalf of myself, the above referenced participants, and/or my child(ren) file or otherwise initiate a lawsuit against SLTC, whether to dispute or enforce the terms of this Agreement or to declare rights hereunder or for any other reason, the prevailing party in any such action shall be entitled to court costs and reasonable attorney’s fees to be paid by the non-prevailing party as fixed by the judge, court arbitrator, or arbitration panel having jurisdiction over the matter. ** I further grant SLTC the right, without reservation or limitation, to videotape, and/or record me and /or my children on closed circuit television. I further grant SLTC the right without reservation or limitation, to videotape, and/or record me and /or my children and to use my child(ren)’s name, face, likeness, voice, and appearance in connection with exhibitions, publicity, advertising, and promotional material. I would like to receive free email promotions and discounts to the email address provided below. I may unsubscribe from emails from Pro Performance Athletics at any time. *By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I have waived my right to maintain a lawsuit against SLTC on the basis of any claim from which I have released them herein as well as any claim of any kind of nature arising out of SLTC sports performance, team training’s, games or activities, absent gross negligence on the part of PPA. I have had sufficient opportunity to read this entire document. I understand this Agreement and I voluntarily agree to be bound by its terms. I further certify that I am either (18) years old or older, or that I am the parent or legal guardian of the child(ren) listed above on this Agreement, or that I have been granted power of attorney to sign this agreement on behalf of the parent or legal guardian of the child(ren) listed above.Parent/Legal Guardian/Participant Signature (if 19 or older)* First Last Date* Date Format: MM slash DD slash YYYY Parent/Legal Guardian/Participant InfoBirth Date MM DD YYYY Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country PhoneEmail* Emergency Contact NameEmergency Contact PhonePhoneThis field is for validation purposes and should be left unchanged.