Client Registration Form

CLIENT REGISTRATION

Pros of the Rope (POTR), LLC

TODAY'S DATE

EVENT DATE*

EVENT TIME*

TYPE OF EVENT

REQUESTED TIME FOR POTR

BUSINESS NAME

CONTACT PERSON

EVENT ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

E-mail*

ESTIMATED NUMBER OF PARTICIPANTS*

AGE GROUPS*

ACTIVITY LOCATION i.e. gym

DO ANY OF YOUR PARTICIPANTS HAVE ANY MEDICAL CONDITIONS WE SHOULD BE AWARE OF?

YESNO

IF YES, PLEASE EXPLAIN;

Agreement and Disclosure

Activities at Pros of the Rope, LLC involve moderate to high energy expenditure levels. It is recommended that students know the status of their health and any limitations on their ability to safely participate in classes. I understand that Pros of the Rope, LLC and its instructors are not liable for injuries sustained or illnesses contracted by the student while attending the program. I grant permission for the event images to be used for Pros of the Rope marketing or promotional purposes (advertisements, posters, Facebook, Twitter, Instagram, etc.)

Signature*

Sign by using a touch tablet/screen or left click and hold as you sign with your mouse.