NAME:

ADDRESS: CITY: STATE/ZIP:

PHONE #                                 CELL #                         TEXT Y / N

EMAIL:

EMERGENCY CONTACT / PHONE:

I, __________________________________, agree to participate in one or more camps, clinics, training and physical fitness program(s)/ class(es) sponsored by Next Level Athletic Association ("NLAA"), which may include, but not necessarily be limited to, NLAA, Dream Team Marketing LLC, Total Sports Management LLC, SportsWorx, University of South Florida, University of outh Florida Board of Governors and employess, State of Florida and/or training of any kind, by any affiliate, subsidiary, sponsor or partnership of NLAA. NLAA made me fully aware that the all said camps, clinics, training and fitness programs/classes which NLAA offers, and which I desire to participate are of a nature and kind that are extremely strenuous and can/may push me to the limits of my physical abilities. I, the undersigned, recognize and understand that the programs/classes are not without varying degrees of risk which may include, but are not limited to the following: Injury to the musculoskeletal and/or cardio respiratory systems which can result in serious injury or death, injury or death due to negligence on the part of myself, my training partner, or other people around me, injury or death due to improper use or failure of equipment, or injury or death due to medical condition, whether known or unknown by me. I am aware that any of these above mentioned risks may result in serious injury or death to myself and or my partner(s).

I willingly assume full responsibility for any and all risks that I am exposing myself to as a result of my participation in NLAA program/classes and accept full responsibility for any injury or death that may result from participation in any activity, class or physical fitness program. I herby certify that I know of no medical problems that would increase my risk of illness and injury as a result of participation in a fitness program designed by NLAA. NLAA informed me that there exists the possibility of adverse physical changes during an exercise program, and I fully understand the same. NLAA informed me that these changes could include abnormal blood pressure, fainting, disorder of the heart rhythm, stroke, and in very rare instances, heart attack or even death, and I fully understand the same. With my full understanding of the above information, I agree to assume any and all risk associated with my participation in NLAA camps, clinics, and training and fitness programs/classes.

In full consideration of the above mentioned risks and hazards and in full consideration of the fact that I am willingly and voluntarily participating in the activities made available by Next Level Athletic Association, and with full understanding of all of the above, I hereby waive, release, remise and discharge NLAA and its agents, officers, principals and employees and volunteers, of any and all liability, claims, demands, actions or rights of action, damages of any kind related to, arising from, or in any way connected with, my participation in NLAA camps, clinics, training and fitness programs/classes, including those allegedly attributed to the negligent acts or omissions of the above mentioned parties.

This agreement shall be binding upon me, my successors, representatives, heirs, executors, assigns, or transferees. If any portion of this agreement is held invalid, I agree that the remainder of the agreement shall remain in full legal force and effect.

If I am signing on behalf of a minor child, I also give full permission for any person connected with NLAA to administer first aid deemed necessary, and in case of serious illness or injury, I give permission to call for medical and or surgical care for the child and to transport the child to a medical facility deemed necessary for the well being of the child.

I recognize that there is risk involved in the types of activities offered by Next Level Athletic Association. Therefore I accept financial responsibility for any injury that I or the participant may cause either to him/herself or to any other participant due to his/her negligence. Should the above mentioned parties, or anyone acting on their behalf, be required to agree to indemnify and hold harmless Next Level Athletic Association, their principals, agents, employees, affiliates, subsidiaries, partners and volunteers from liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in activities offered by Next Level Athletic Association.

I agree to allow NLAA, its agents, officers, principals, employees and volunteers the use of a picture(s), film and/or likeness of me for advertising purposes. In the event I choose not to allow the use of the same for said purpose, I agree that I must inform NLAA of this in writing.

/ /

PARTICIPANT’S NAME (PLEASE SIGN)

/ /

LEGAL GUARDIAN (PLEASE SIGN)