PARENT WAIVER

Theorem Performance & Lifestyle Parental Waiver

THEOREM PERFORMANCE & LIFESTYLE

Parental Waiver, Release of Liability, Indemnification and Consent Form

I, the undersigned, as the parent or legal guardian of the child named below, do hereby give my full consent and approval for my child to participate in programs, classes, clinics, workouts, strength training, agility training and physical conditioning or any activity akin to these provided by the employees of, and/or the independent contractors associated with Theorem Performance & Lifestyle and/or its approved affiliates.

I understand that by its very nature, any participation in physical activity is hazardous and risky. I understand that there are certain risks of serious injury, or even death, inherent in physical training and play and in the other activities that occur during the session(s) my child will attend. There are also risks including, but not limited to, hazards associated with weather conditions, travel on and off site, training conditions and equipment. I am willing to assume these risks on behalf of my child.

I agree that in consideration for the right to allow my child to participate in the activities described above and/or participate as a participant of a program offered by Theorem Performance & Lifestyle and/or its approved affiliates:

1. On behalf of my child and myself, I voluntarily elect to accept and solely assume all risks of injury incurred or suffered by my child (a) while participating in the activities described above; (b) while training or playing as a participant of Theorem Performance & Lifestyle and/or its approved affiliates (c) while on or off training premises or locations during, before and after scheduled training sessions.

2. In addition to giving my full consent for my child’s participation, I do hereby waive, release, discharge and agree not to sue (a) Theorem Performance & Lifestyle, its founders, Matthew-Grae Chapdelaine and/or Kelsey Chapdelaine, its approved affiliates and/or independent contractors (b) the owner or operator of any facility or premises that my child will be participating at for any claim, damages, costs including attorneys fees, or cause of action which I or my child have or may have in the future as a result of damages, injuries, including death, sustained or incurred by my child from whatever cause including, but not limited to, the negligence, breach of contract or wrongful conduct of the parties hereby released.

I hereby certify that my child is fully capable of participating in physical activity and the activities described above and that my child is healthy and has no physical or mental disabilities or infirmities that would restrict his or her full participation in these activities. I further agree on behalf of myself and my child named below, that I shall hold harmless and fully indemnify the parties hereby released from any and all claims, cause of action, damages and costs, including attorney fees, which may arise from any claim or cause of action brought by me or by, through or on behalf of my child, even if the damages, injuries or death are caused in whole or in part by any of the persons or entities herby released. I acknowledge that I have read (or have had read to me) each and every one of the provisions in this waiver, release of liability and indemnification agreement, that I understand each of the provisions in this agreement and that I agree to abide by them.

Once all requires fields have been met, please check one more time to confirm that everything has been adequately read and understood, and that all of the information you have provided is complete and accurate. If you feel confident that everything is in order, you may click submit below and your information will be sent to Matt Chapdelaine. If you have any questions or concerns regarding this form, you may email Matt Chapdelaine to address those items at matt.teamtheorem@gmail.com

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