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 Program Release

Electronic Signature *
Electronic Signature
I the undersigned patron of ARCHITECH SPORTS AND PHYSICAL THERAPY, INC. (ARCHITECH SPORTS) hereby state and represent as follows: 1.     I have no known medical problems that would preclude me from participation in any of ARCHITECH SPORTS’ programs, and the information I have provided to ARCHITECH SPORTS regarding my medical condition and physical condition is true and correct to the best of my knowledge. 2.     My participation in any of ARCHITECH SPORTS’ programs is voluntary, and I have the right to withdraw from any of the programs at any time.If I withdraw from the programs, however, I am still responsible for any monetary obligations that I may have incurred in the course of my participation. 3. Neither ARCHITECH SPORTS, nor any of it agents or representatives, has guaranteed me success in any of the programs. 4.     I hereby agree to forever waive any and all claims that I have against ARCHITECH SPORTS or its agents or employeesas a result of my participation in any of ARCHITECH SPORTS’ programs. This release shall be binding on my heirs, legal representatives and assigns. 5.     I hereby consent to and permit ARCHITECH SPORTS to use the data obtained as a result of my participation in ARCHITECH SPORTS’ programs in reports or publications, but my identity will not be revealed in any such reports unless I have given my specific consent to do so. 6.     I am aware of ARCHITECH SPORTS’ late/no show policy, which states that if I do not show up for my appointment within 15 minutes of the session time, ARCHITECH SPORTS has the option of counting that session as if it were used. 7.     I am aware that any sessions remaining in my program will be forfeited if not used within one year, unless alternate arrangements have been with ARCHITECH SPORTS in advance. 8.     In the event of physical injury resulting from my participation in any of ARCHITECH SPORTS’ programs, no medical or monetary compensation will be provided to me by ARCHITECH SPORTS. I will assume and pay, either personally or through my own medical insurance coverage, for all medical bills or expenses incurred as a result of my participation in ARCHITECH SPORTS’programs. 9.     Risk and discomforts: When participating in athletic development programs, as with any sport/athletic activity, thereexists the possibility of straining muscles and spraining ligaments. ARCHITECH SPORTS will try to minimize these risks. It is not uncommon to experience some delayed onset muscle soreness when starting a conditioning program. I have read this release and the information provided to me by ARCHITECH SPORTS, and I understand that I am signing a complete release from any claim resulting from my participation in any of ARCHITECH SPORTS’ programs.
Parent or Guardian *
Parent or Guardian
Electronic signature The above-named client is under the age of 18 years. I have reviewed the information provided and certify it to be true and correct. I represent that the client is currently covered under my medical insurance, and I consent to the athlete named above participating in ARCHITECHSPORTS’ PROGRAMS.