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ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM APX360 Health, Fitness & Sports Performance

APX360.COM I give permission for the undersigned participant to participate in the APX360 Health, Fitness & Sports Performance (APX360 HF&SP) event. I understand that the APX360 HF&SP event’s activities may involve certain risks of physical activity and possible injury and that APX 360 HF&SP will provide each participant with reasonable care, but that APX360 HF&SP cannot guarantee that the undersigned participant will remain free of injury. I nonetheless wish to have my child participate in the APX360 HF&SP and ASSUME the RISK of participating. I agree to RELEASE from LIABILITY, INDEMNIFY and HOLD HARMLESS the entities in this paragraph (hereinafter the RELEASEES) from any and all claim and/or cause of action arising out of and related to any injury, loss, penalties, damage, settlement, costs or other expenses or liabilities that occur as a result of my child’s participation in the APX360 HF&SP event. This release, however, is not intended to release the above-mentioned RELEASEES from liability arising out of their sole negligence. THE PARTICIPANT: I certify that I am physically fit, have sufficiently prepared or trained for participation in the activity or event, and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems that preclude my participation in this activity or event. I acknowledge that this Accident Waiver and Release of Liability Form will be used by the event holders, sponsors, and organizers of the activity or event in which I may participate, and that it will govern my actions and responsibilities at said activity or event. I acknowledge that APX360 HF&SP and their directors, officers, volunteers, representatives, and agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific event or activity on their behalf. I acknowledge that this activity or event may involve a test of a person's physical and mental limits and carries with it the potential for death, serious injury, and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, wildlife, condition of participants, equipment, vehicular traffic, actions of other people including, but not limited to, participants, volunteers, spectators, coaches, event officials, and event monitors, and/or producers of the event, and lack of hydration. These risks are not only inherent to participants, but are also present for volunteers. I hereby consent to receive medical treatment that may be deemed advisable in the event of injury, accident, and/or illness during this activity or event. I understand that APX360 HF&SP is not responsible for lost or stolen items. I understand that at this event or related activities, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the event holders, producers, sponsors, organizers, and assigns. The Accident Waiver and Release of Liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. I CERTIFY THAT I HAVE READ THIS DOCUMENT; AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL. _______________________________________ PARTICIPANT’S NAME & AGE SIGNATURE DATE EM

(If under 18 years old, Parent or Legal Guardian must sign)

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APX360.COM PARTICPANT  INFORMATION    First  Name:                 Last  Name:                  Address:                                                                     City:                  State:               Zip:                  Phone:                  Sport:                          Position/s:                    Age:                      Email:                            PARENT’S/LEGAL  GUARDIAN’S  INFORMATION    Name:                             Phone:                Email:                            Name:                         Phone:                Email:                            EMERGENCY  CONTACT  INFORMATION    Name:                    Relationship:              Cell:                Home:                        MEDICAL  HISTORY  (please  briefly  describe  any  medical  conditions/limitations  that  we  need  to  be  aware  of:  i.e.  Asthma)