Waiver

Name of Person Digitally Signing this form

First Name

Last Name

Email

Phone

(###)

###

####

Emergency Contact

Please include a name and number

Name of minor participant (if applicable)

First Name

Last Name

Birth Date of Minor

MM

DD

YYYY

Name of 2nd minor applicant (if applicable)

First Name

Last Name

Birth date of 2nd minor

MM

DD

YYYY

Name of 3rd minor (if applicable)

First Name

Last Name

Birth date of 3rd minor

MM

DD

YYYY

By checking the box below, I certify that I am the person whose name appears on this form or the legal guardian if the person's name whose appears is a minor.

I am signing for myself and acknowledge submission of this form represents my digital signature.

I am the legal guardian for the minor named above and acknowledge submission of this form represents my digital signature..

Today's Date

MM

DD

YYYY

I, the person listed below or my minor child for whom I am the legal guardian (hereafter simply referred to as “I” or “Participant,” as applicable), will be participating in the movement program offered by The Rasta Method LLC, based in the greater Washington DC region (16010 Excalibur Rd, D007, Bowie, MD 20716). I recognize that the program may involve strenuous physical activity including, but not limited to, muscle strength and endurance training, cardiovascular conditioning, and other various fitness activities. I hereby affirm that I am in good physical condition and do not suffer from any known disability or condition which would prevent or limit my participation in this program or otherwise have clearance from my medical provider to engage in such a program. I acknowledge that my enrollment and subsequent participation is purely voluntary and in no way mandated by any entity. Any participation or recommendation taken against a physician’s orders are made solely at my own choice with understanding to the risk therein. This program, the content therein, and any advice by affiliated instructors of the program, is not intended to be or to substitute any professional medical advice, diagnosis, or treatment and does not constitute medical advice and I understand I should speak with my physician for such diagnoses, treatments, and advice.

In consideration of my participation in this program, I, the person listed at the bottom of this waiver, hereby release The Rasta Method LLC and all associated entities from any claims, demands, and causes of action, as a result of my voluntary participation.

I fully understand that I may injure myself as a result of my subsequent participation in this program and I, the undersigned, hereby release The Rasta Method LLC and all associated entities from any liability now and in the future for conditions that I or my minor child for whom I am the legal guardian may obtain as a result of my participation in activities directly or indirectly related to my involvement therein. These conditions may include, but are not limited to, heart attacks, muscle strains, muscle pulls, muscle tears, broken bones, shin splints, heat prostration, injuries to knees, injuries to back, injuries to foot, or any other illness or soreness that I may incur, including death. The Rasta Method LLC and associated entities shall not be liable for any direct or indirect damages otherwise as a result of my voluntary participation in this program.