top of page
Home
Online Training
Paralysis Recovery
Contact Me
More
Use tab to navigate through the menu items.
Branfunction Liability Waiver
First name
Last name
Email
Date of Birth
Do you have a doctor’s permit to participate in intense physical activities?
No
Yes
Please specify anything we should know about
Initials
I declare that the info I’ve provided is accurate & complete
I hereby acknowledge this release from liability for accidental injury or illness which I may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.
Submit
Thanks for submitting!
bottom of page