SportsCan Open Gym Registration & Medical Waiver

* 1. Name

* 2. E-mail

* 3. Gender

* 4. Skill Level- definition of each level is on the website

* 5. I acknowledge that there are potential risks in physical activity programs. I assume those risks and consent to the proposed participation in this program. I, or any person claiming through me or on my behalf, do hereby release and agree to save harmless Sportscan Corp. and their officers, employees or agents, from claims for loss, injury or damage to persons and property while participating in this program, or travelling to or from this program, except when Sportscan Corp. and/or its agents are negligent.

* 6. Signature (Hard Copy), Type Name (Electronic Copy):

* 7. Emergency Contact Information