Fitness Conditioning FSE

Registration

All fields are required unless indicated as optional.

First Name

Last Name

Mailing Address

(optional) Mailing Address 2

City

State

Zip Code

Email Address

Cell Phone Number

OK to send text messages?
Yes
No

(optional) If you would like to be contracted on social media sites, then please provide your account name or page.

Twitter Name
LinkedIn Page
FaceBook Name

How do you receive and view media? Check all that apply.

Cell phone text message
Streaming Online Video (YouTube, FaceBook, etc.)
Email attachment (download and view content)
Other

Please select your age range.

18-25 26-30 31-35 36-40
41-45 46-50 51-55 56-60
61-65 >65

What is your height?

Feet Inches

What is your weight?

Lbs

(optional) Past or current sports injuries? Please describe.

Which type(s) of exercise facilities do you have access to? Check all that apply.

Fitness or Rec Center/Gym
Outdoor or Indoor Track
Other

Which physical exercises do you currently engage in? Check all that apply.

Tennis Weightlifting Running/Jogging
Aerobics Yoga Cycling Racquetball
Basketball Martial Arts
Other

Which days of the week can you schedule a workout? For how much time?

Sunday	<30 30-60 60-90 >90
Monday	<30 30-60 60-90 >90
Tuesday	<30 30-60 60-90 >90
Wednesday	<30 30-60 60-90 >90
Thursday	<30 30-60 60-90 >90
Friday	<30 30-60 60-90 >90
Saturday	<30 30-60 60-90 >90

What are your goals and expectations of this training program?

Number of Years as Official

Years

Sport(s) you officiate Check all that apply.

Football
Basketball
Soccer
Lacrosse
Rugby
Other Sport

What is/are your Officiating Position(s)? Check all that apply.

Referee
Umpire
Back Judge
Center Judge
Deep Wing
Line of Scrimmage
Other Position

Officiating Conference(s)

Conference 1
Conference 2
Conference 3

Officiating Level. Check all that apply.

High School
College
Professional

Release of Liability
Please scroll to read the release in its entirety

In consideration for participating voluntarily in the fitness and training program, the "Program", the undersigned, the "Participant", for themselves, and for their respective heirs, personal representatives and assigns, agree as follows:

Assumption of Risk:
The undersigned hereby acknowledge and agree that they understand the nature of the Event; that Participant is qualified, in good health, and in proper physical condition to participate therein; that there are certain inherent risks and dangers associated with the Program; and that, except as expressly set forth herein, they, knowingly and voluntarily, accept, and assume responsibility for, each of these risks and dangers, and all other risks and dangers that could arise out of, or occur during, Participant’s participation in the Program.

Release and Waiver:
The undersigned hereby RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE Fitness & Sports Excellerated, LLC and its member
institutions, or any subdivision thereof, and each of them, their officers and employees, collectively, the “Releasees”), from and for any liability resulting from any personal injury, accident or illness (including death), and/or property loss, however caused, arising from, or in any way related to, Participant’s participation in the Program.

Indemnification and Hold Harmless:
The undersigned also hereby agree to INDEMNIFY, DEFEND AND HOLD the Releasees HARMLESS from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities including, but not limited to, attorney’s fees, arising from, or in any way related to, Participant’s participation in the Event, except for those arising out of the willful misconduct, gross negligence or intentional torts of the above parties, as applicable.

Permission to Use Likeness/Name:
The undersigned further agree to allow, without compensation, Participant’s likeness and/or name to appear, and to otherwise be used, in material, regardless of media form, promoting Fitness & Sports Excellerated, and/or its programs, events and activities, including those of its representatives and licensees.

Severability:
The undersigned expressly agree that the foregoing assumption of risk, release and waiver of liability and indemnity agreement is intended to be as broad and inclusive as is permitted by the law of the State of Ohio and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

Acknowledgment of Understanding:
The undersigned have read this assumption of risk,release and waiver of liability and indemnity agreement, and have had the opportunity to ask questions about the same. The undersigned fully understand this assumption of risk, release and waiver of liability and indemnity agreement, that the undersigned are giving up substantial rights in connection therewith, and that its terms are contractual, and not a mere recital. The
undersigned acknowledge that they are signing this agreement freely and voluntarily.

The undersigned agree that clicking the agreement checkbox, typing full name into the agreement text field and selecting the agreement current date constitute their electronic signature.

To agree to this waiver, please check the box below, type your full name into the textbox and select the date.

I agree to the above release
Full Name
Date of Agreement

Game Ready
Officials Package and Membership Fees

Please select the preferred prepaid package

One Month: $200.00
Four Month: $500.00 (savings of $75 per month)
Six Month: $600.00 (savings of $100 per month)

Preferred Payment Method

PayPal
Check/Money Order
Zelle
Other

Promo Code

Please enter a valid promo code.

Game Ready Online Training

Officials:
The overlooked athletes,
Let's change that.