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Rise Athletic Training

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Photo/Video Consent & Release

First Name

Last Name

Email

Date of Birth

Initials

I hereby give consent to be in photographs/videos to be used for any media and marketing purposes.

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Liability Waiver

Participant Name

Participant Date of Birth

Email

Emergency Contact Name

Emergency Contact Phone Number

Is the participant covered by insurance?

Yes

No

Please specify anything we should know about (injuries, limitations, alergies, medications, etc.)

I declare that the info I’ve provided is accurate & complete

I hereby acknowledge this release from liability for accidental injury or illness which may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose physical limitations, disabilities, ailments, or impairments which may affect ability to participate in this program

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Rise Athletic Training

240 Mayfield Rd.

Morgantown, WV

riseathletictraining@gmail.com

304.508.2707

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