SCHULER CHIROPRACTIC
CARDIO CLUB
MEMBERSHIP APPLICATION WAIVER
The following waiver MUST BE SIGNED BY NEW AND
RENEWING MEMBERS for the
application to be processed.
GENERAL INFORMATION
Name(s):__________________________________________________________
Address:__________________________________________________________
City: _________________________State: _______Zip Code: ______________
Home Phone: _____________Work Phone: __________E-mail: _____________
Membership Type (check one): New Member [ ] Renewal [ ]
CLUB MEMBERSHIP APPLICATION WAIVER
I know that cardio exercise and volunteering to work in the Schuler Chiropractic Cardio Club are potentially hazardous activities. I should not enter and do cardio exercise in the club or club activities unless I am medically able and properly trained. I assume all risks associated with cardio exercise and volunteering in club activities including, but not limited to, falls, contacts with other participants, the effects of the weather, including high heat and/or humidity, the conditions of the road and traffic on the course, all such risks being known, for any and all injuries, including death, and property damage in any manner arising or resulting from my participation in Schuler Chiropractic Cardio Club . Having read this waiver and knowing these facts, and in consideration of your acceptance of my application for membership, I, for myself and anyone entitled to act on my behalf, waive and release the Schuler Chiropractic Cardio Club , Schuler Chiropractic and all sponsors, their representatives and successors from all claims and liabilities of any kind arising out of my participation in these club activities even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver.
I grant permission to all the foregoing to use any photographs, motion pictures, recordings, or any other record of club activities for any legitimate purpose.
Signature(s):__________________________________ , ___________________________________
Date:_______________________
PARENTS ACKNOWLEDGEMENT, RELEASE AND WAIVER: I, the parent or legal guardian of the above
applicant, hereby acknowledge that I approve of my child participating in this club. I agree that my child and I shall be bound by the above release and waiver.
_______________________________________________________________
Signature of Parent/Guardian (if participant is under 18)
For those CHARGING through Life!!!!