Mobile Phone * How did you hear about RPP? * Have you ever had a professional license disciplined or revoked? * Have you ever been convicted of a crime (including sex or child abuse)? * EDUCATIONAL INFORMATION High School, City and State * HS Graduation Year * _______________ 1. College, City and State Degree and Graduation Year _______________ 2. College, City and State (if more than one) Degree and Graduation Year CERTIFICATIONS, INTERNSHIPS, OTHER, ETC. List any professional certifications (ATC, CPT, CSCS, etc.) List any certifications achieved through continuing education (FMS, SFMA, etc.) List any prior internships with dates REFERENCES (3 REQUIRED) Relationship * Organization Reference Phone * _______________ Relationship * Organization Reference Phone * _______________ Relationship * Organization Reference Phone * PRIOR EMPLOYMENT HISTORY 1. Company, Address Supervisor Name Supervisor Phone Responsibilities May we contact this employer? Start and End Dates Reasons for Leaving _______________ 2. Company, Address Supervisor Name Supervisor Phone Responsibilities May we contact this employer? Start and End Dates Reasons for Leaving MILITARY SERVICE (IF ANY) Branch of Service Dates of Service Service Rank at discharge DISCLAIMER SIGNATURE APPLICANT INFORMATION RELEASE SIGNATURE LIABILITY WAIVER AND RELEASE SIGNATURE Liability Waiver and Release Signature * Clear Signature
LIABILITY WAIVER AND RELEASE FORM (ADULT) - THIS IS A RELEASE OF LEGAL AND OTHER RIGHTS IF WERE TO JOIN US AS AN INTERN PURSUANT TO THIS APPLICATION (READ AND UNDERSTAND BEFORE SIGNING) I understand and acknowledge that I am fully aware of and assume the risks (including but not limited to the risk of serious bodily injury, property loss or damage) of (1) participation in Activities (as defined below) at Rockland Peak Performance Inc. (“RPP”) or on a remote basis. I understand that certain Activities can be strenuous and subject to risk of serious injury, and acknowledge that I have been hereby advised to obtain a physical examination and understand and that RPP shall have no responsibility to pay for medical treatment, related costs or any other costs arising from such Activities if I get injured in any way. I further understand and agree that RPP supplies training equipment “as is”, and that RPP disclaims all warranties, express or implied, for any particular use or purpose. Knowing the risks described above, I agree to assume all the risks and responsibilities surrounding my participation in such Activities to be provided by RPP. To the fullest extent allowed by law, I hold harmless and agree to indemnify RPP, its officers, directors, faculty, staff, volunteers, employees and agents, from and against any present or future claim, cause of action, loss or liability for injury to person or property, which I may suffer or may be liable to any other person, related to my participation in Activities at RPP, resulting from any cause whatsoever, and regardless of fault. I am at least eighteen years of age and have carefully read and freely signed this Liability Waiver and Release Form. I understand and agree that no oral or written representations can or will alter the contents of this document. I agree that this agreement shall be governed by the laws of the State of New Jersey (excluding its conflict of laws principles). “Activities” (including, without limitation, 1) participation on strength and conditioning and fitness programs, 2) use of all amenities and equipment in the facility and your participation in any activity, class, program, personal training or instruction, 3) the sudden and unforeseen malfunctioning of any equipment, 4) our instruction, training, supervision, or dietary recommendations, 5) your slipping and/or falling while in the building, or on the premises, including adjacent sidewalks and parking areas, 6) contact with other participants, 7) the effects of the weather, including high heat and/or humidity, and all other such risks being known and appreciated by me) in person or on a remote basis through online access with RPP. I also hereby grant permission for photographs or video of me to be taken and to be used for instructional purposes, publicity, and/or program purposes, including on the RPP website or social media purposes.