Athlete Name *

First

Last

University, College, School. etc. *

Athlete Cell Phone *

Parent Name (if athlete a minor)

First

Last

Parent Cell Phone (if athlete a minor)

Athlete Email (or parent email if a minor) *

Email

Confirm Email

Address *

Address Line 1

City

State

Zip Code

Age *

Throws / Bats (R/L) *

R/R
R/L
L/L
L/R

Postion *

Pitcher
Position Player

Pain / Injury / Surgery Information

Recent or Current Pain (N/A if none) *

Prior Injuries (N/A if none) *

Prior Surgeries (N/A if none) *

Do you have any medical limitations? (N/A if none) *

Liability and Waiver Release Agreement *

I hereby agree to Liability Waiver and Release as outlined herein.

LIABILITY WAIVER AND RELEASE FORM
THIS IS A RELEASE OF LEGAL RIGHTS (READ AND UNDERSTAND BEFORE SIGNING)
I hereby certify that I am the athlete (or the parent / guardian of the athlete, a minor child under the age of eighteen years) that is the signatory to this agreement.
I understand and acknowledge that I am fully aware of and assume any and all the risks (including but not limited to the risk of serious bodily injury, property loss or damage) associated with participation in Activities (as defined below) provided by Rockland Peak Performance Inc. (“RPP”). 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 further understand and that RPP shall have no responsibility of any kind to pay for medical treatment, related costs or any other costs arising from such Activities if I get injured in any way.
Knowing the risks described above, I agree to assume any and all the risks and responsibilities surrounding my participation in such Activities to be provided by RPP, even if and when performed on a remote basis. To the fullest extent allowed by law, I hold harmless and agree to indemnify RPP, its officers, directors, faculty, staff, coaches, 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 or on a remote basis, resulting from any cause whatsoever, and regardless of fault.
Activities include, without limitation 1) participation in any and all evaluations and recommendations pertaining to mobility, strength training, conditioning, other training, throwing, pitching and hitting programs, any evaluation, instruction, supervision or other physical activities provided by RPP to be performed at RPP or on a remote basis outside the facility, and 2) and all other related risks being known or unknown and appreciated by me in person or on a remote basis through online access with RPP.
I 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 further understand that I am signing a complete release from any and all claims resulting from my participation in any of RPP’s evaluation and programs whether in-person at RPP or on a remote basis. I agree that this agreement shall be governed by the laws of the State of New Jersey (excluding its conflict of laws principles).

Signature *

Clear Signature