I, the undersigned, being aware of my own health and physical condition, and having knowledge that my participation in any exercise program may be injurious to my health, am voluntarily participating in a physical activity. Having such knowledge, I hereby acknowledge this release, Jason D Fitness and all business associates, affiliates, any representatives, coaches, agents, and successors from liability for accidental injury or illness which I may incur as a result of participating in the said physical activity. I hereby assume all risks connected therewith and consent to participate in said program. I agree to disclose any physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in said fitness program. *

I understand and agree to the liability waiver.

Name *

First Name

Last Name

Phone Number *

Country

(###)

###

####

Company/Group Name *

GovGuam

Federal

Judiciary of Guam

Checkbox *

Subscriber

Dependent

Date of Birth *

MM

DD

YYYY

Camp Location (you may choose more than one) *

Tamuning

Dededo AM

Dededo PM

Adelup

Hagat

Mangilao