Have an account?

Please fill out this form of liability prior to participating and engaging in online services to release & discharge BINDZONE from any and all claims or causes of action, known or unknown, arising out of BINDZONE's services. If you are under the age of 18, please let BINDZONE know and provide us with your parent's information as well.

Liability Waiver

First name

Last name

Email

Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

Please specify anything we should know about regarding your body's physical abilities and limitations (injury, disability, etc.):

Do you have a doctor’s permit to participate in physical activities?

Yes

No

N/A

I am ...

Over 18 years old

Under 18 years old

Date of Birth

Month

Day

Year

If you're under 18 years old, please provide your parent's first and last name, phone number, and email.

Gender Identity:

Female

Male

Other

This is asked due to 1:1 coaching being for women only at this time. Thank you for your understanding (:

How did you hear about us?

If you were referred, please enter name of your friend / family below

I understand that participation in these services could include actions that may be dangerous to me and potentially cause injury if they aren't done properly

I understand

If you choose to participate in BINDZONE's services, you agree to do so at your own risk, voluntarily, & assume all risk of injury to yourself.

I agree

I agree to the terms & conditions listed above, and don't hold BINDZONE liable for any form of potential injury.

By signing this waiver, I acknowledge the inherent risks and voluntarily assume full responsibility for any injury, damage, or loss that may result from my participation. I hereby waive and release BINDZONE, its owners, and its staff from any and all liability, past, present, and future, relating to the services provided.

Today's Date

Month

Day

Year

Signature

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