Waiver Form - Em Speed & Power Training printable pdf download

Waiver Form - Em Speed & Power Training

EM Sports, LLC 12067 Arrow Rte. Rancho Cucamonga, CA 91701

Athletes Name

Mom / Dad’s Name

Mom

Dad

School / Team

Main Sports (s)

Mom / Dad’s Cell

Mom

Dad

Your Cell

Street Address

City and Zip

Email Address

Birthday mm/dd/yyyy

Coach Name

In your opinion, which areas do you need the most improvement? (Circle one or more)!

SPEED AGILITY JUMPING STRENGTH BODY STYLE FLEXIBILITY

ALL!

Other______________________________________________________________!

EM is an aggressive exercise program, please let us know of any condition (no matter how small) that

might concern you or limit you from participating in this program.

Asthma

Diabetic

Allergies

Heart Condition

________

Other

In the past 12 months have you had an injury?

Describe ________________________________________________________________

In the past 24 months have you had surgery, or have you been diagnosed with any

condition by a doctor that will limit you from physical activity?

Describe ________________________________________________________________

We highly suggest that you get clearance from your medical doctor and see a licensed Physical

Therapist before participating in an aggressive fitness regimen such as EM :

Physical Performance Screening*

Opt Out

*In addition to clearance from a medical doctor, we suggest you seek the advise of a sports

specific Physical Therapist to help identify existing or potential injury areas. In some locations

EM works with a Physical Therapy service that can provide a ‘Physical Performance

Screening’ at an additional cost.

Waiver Form - Em Speed & Power Training