Parent/ Guardian Waiver of Release and Informed Consent

Participation in COPPER STAT FIT program requires the consent of a parent or legal guardian if under the age of 18.

INFORMED CONSENT:

Name of client under 18 years of age(required)

Name of parent/ legal guardian(required)

Email of parent/ legal guardian(required)

Phone number of parent/ legal guardian(required)

As a condition of participating in COPPER STATE FIT LLC you agree and acknowledge that All information including recommendations regarding diet exercise or dietary supplements is for informational purposes only. COPPER STATE FIT LLC is not a medically supervised program. The information provided is not intended to be used in place of a visit call consultation or advice of a physician or other medical/healthcare professional. We do not recommend the self-management of health problems. If you have any healthcare-related questions promptly call or see your physician or other healthcare provider. Never disregard medical advice or delay in seeking medical advice because of something you have read or discussed with COPPER STATE FIT LLC. Never use information provided for diagnosing a health problem or prescribing or using a medication. Information and statements concerning dietary supplements have not been evaluated by the Food and Drug Administration (FDA) and are not intended to diagnose treat cure or prevent any disease. Additionally the transmission and receipt of information in whole or in part or communication via the internet phone text e-mail or other does not constitute or create a doctor-patient therapist-patient or other healthcare professional relationship between you and COPPER STATE FIT LLC. Participation in the COPPER STATE FIT LLC program involves the risk of injury whether you or someone else causes it. Specific risks vary during participation in the COPPER STATE FIT LLC program from one activity to another and the risks range from minor injuries to major injuries such as catastrophic injuries including death. In consideration of your participation in the COPPER STATE FIT LLC program you understand and voluntarily accept the risks and agree that COPPER STATE FIT LLC and their officers directors employees volunteers agents and independent contractors will not be liable for any injury including without limitation personal bodily or mental injury economic loss or any damage to you your spouse guests unborn child or relatives resulting from the negligence of COPPER STATE FIT LLC or anyone on behalf of COPPER STATE FIT LLC. I hereby consent to voluntary participation in the COPPER STATE FIT LLC program. I have read and fully understand both the risks and benefits of the COPPER STATE FIT LLC program. Furthermore the level of training and credentials of those providing the program have been disclosed to me. All costs of this program have been or will be outlined for me including any costs of additional food or supplements and additional services.(required) I AGREE with the terms and conditions and I am the parent/ guardian of the client. I give consent for client to participate in the program.

I DO NOT AGREE with the terms and conditions and I am the parent/ guardian of the client named. I DO NOT give consent for client to participate in the program.

If you have any further questions, please do not hesitate to contact me here: adam@copperstatefit.com