ALERT
Please complete all areas, read, sign where indicated and click "SUBMIT" at the bottom of the registration page

REGISTRATION FORM

Minor Participant Information:

*Note: if your child does not appear below, please click the "Back" button to add them on previous screen.

DATE:
NAME: <CHILDFIRSTNAME> <CHILDLASTNAME>
E-MAIL ADDRESS:
DOB: <CHILDBIRTHDAY>	AGE: <CHILDAGE>
GENDER: MALE FEMALE Prefer not to say
SHIRT SIZE:
SPORT:
LEVEL:

DATE:
NAME: <CHILDFIRSTNAME> <CHILDLASTNAME>
E-MAIL ADDRESS:
DOB: <CHILDBIRTHDAY>	AGE: <CHILDAGE>
GENDER: MALE FEMALE Prefer not to say
SHIRT SIZE:
SPORT:
LEVEL:

DATE:
NAME: <CHILDFIRSTNAME> <CHILDLASTNAME>
E-MAIL ADDRESS:
DOB: <CHILDBIRTHDAY>	AGE: <CHILDAGE>
GENDER: MALE FEMALE Prefer not to say
SHIRT SIZE:
SPORT:
LEVEL:

DATE:
NAME: <CHILDFIRSTNAME> <CHILDLASTNAME>
E-MAIL ADDRESS:
DOB: <CHILDBIRTHDAY>	AGE: <CHILDAGE>
GENDER: MALE FEMALE Prefer not to say
SHIRT SIZE:
SPORT:
LEVEL:

DATE:
NAME: <CHILDFIRSTNAME> <CHILDLASTNAME>
E-MAIL ADDRESS:
DOB: <CHILDBIRTHDAY>	AGE: <CHILDAGE>
GENDER: MALE FEMALE Prefer not to say
SHIRT SIZE:
SPORT:
LEVEL:

DATE:
NAME: <CHILDFIRSTNAME> <CHILDLASTNAME>
E-MAIL ADDRESS:
DOB: <CHILDBIRTHDAY>	AGE: <CHILDAGE>
GENDER: MALE FEMALE Prefer not to say
SHIRT SIZE:
SPORT:
LEVEL:

DATE:
NAME: <CHILDFIRSTNAME> <CHILDLASTNAME>
E-MAIL ADDRESS:
DOB: <CHILDBIRTHDAY>	AGE: <CHILDAGE>
GENDER: MALE FEMALE Prefer not to say
SHIRT SIZE:
SPORT:
LEVEL:

DATE:
NAME: <CHILDFIRSTNAME> <CHILDLASTNAME>
E-MAIL ADDRESS:
DOB: <CHILDBIRTHDAY>	AGE: <CHILDAGE>
GENDER: MALE FEMALE Prefer not to say
SHIRT SIZE:
SPORT:
LEVEL:

DATE:
NAME: <CHILDFIRSTNAME> <CHILDLASTNAME>
E-MAIL ADDRESS:
DOB: <CHILDBIRTHDAY>	AGE: <CHILDAGE>
GENDER: MALE FEMALE Prefer not to say
SHIRT SIZE:
SPORT:
LEVEL:

DATE:
NAME: <CHILDFIRSTNAME> <CHILDLASTNAME>
E-MAIL ADDRESS:
DOB: <CHILDBIRTHDAY>	AGE: <CHILDAGE>
GENDER: MALE FEMALE Prefer not to say
SHIRT SIZE:
SPORT:
LEVEL:

*EMERGENCY CONTACT INFORMATION:

Name:

Relation:

Phone #:

EXOS Athletes Performance Institue Texas, 7211 Preston Road, Suite T1000 Plano, TX 75024

*The above listed EXOS Facility shall be defined as “EXOS” in the remaining Registration Form pages.

Each athlete is REQUIRED to have a credit card number on file regardless of method of payment. This card may be used for the following:

Extra Services- Your credit card can be charged for additional services not covered in the standard package of training, including, (additional) massages, biomechanical testing (if applicable), nutritional supplements, etc.
Balances Due- ANY BALANCE THAT HAS NOT BEEN PAID WITHIN TWO WEEKS OF YOUR DEPARTURE WILL AUTOMATICALLY BE CHARGED TO YOUR CREDIT CARD

RELEASE AND WAIVER OF LIABILITY

I understand that this Release and Waiver of Liability (“Release”) governs all rights and liabilities directly or indirectly arising out of or related to any “Services,” as that term is defined below. I have read, understand, and agree to be bound by the Terms and Provisions below.

Definitions

“Services” shall mean any and all manner of goods and services offered by Athletes’ Performance, Inc. (“API”) or any other Released Party to you. These services, which may take the form of training, treatment, consulting, and other services, expressly including but not limited to: evaluations; rehabilitation; reconditioning; performance planning; performance training (e.g., strength and conditioning training, speed and quickness training, and plyometric training); recovery and regeneration training; sports nutrition consultation; supplement and nutrition provision; injury reduction and treatment; technical and tactical instruction; performance enhancement; use of API products and any consultation related to any item included in this list.

“Training” shall mean any act, omission, or other activity required of you or carried out by you in relation to the Services. This term shall not be limited, in any way, with respect to any location, site or facility at which any activities related to the Services takes place.

“Released Parties” shall mean Mark Verstegen, API and its affiliates, subsidiaries, and each of their respective partners, members, managers, shareholders, officers, directors, agents, employees, insurers, heirs, agents, successors, and assigns.

Terms and Provisions

The risk of injury from participation in sporting events and other strenuous physical activity, including Training or Services, as well as the contraction of COVID-19 and other infectious diseases, is significant, including the potential for permanent paralysis, other serious injury, and/or death. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS of participation in Training or Services, including, without limitation, risk arising from or relating in any way to the condition of the facilities, equipment, fields, and surrounding premises, the actions of persons other than myself, my own actions, and travel to and from the Training or Services (including, but not limited to, travel services provided by any Released Parties or in any vehicle owned, operated, or associated with any Released Parties). I UNDERSTAND THAT THE RELEASED PARTIES MAKE NO WARRANTIES (WHETHER EXPRESS OR IMPLIED) and shall in no event be responsible or liable for the defective or dangerous condition of the facilities, equipment, fields, and surrounding premises, except to the extent such condition(s) result(s) solely from the gross negligence or intentional acts of any Released Parties.

I AGREE THAT THE RELEASED PARTIES SHALL NOT BE LIABLE for any losses, claims, demands, injuries, illnesses, damages, actions, lawsuits, judgments, fines, penalties, liabilities, costs, expenses (including, without limitation attorneys' and accountants' fees and costs and court costs, whether or not in connection with litigation), or causes of action (collectively, “Damages”) that arise in whole or in part due to the simple negligence of any of the Released Parties.FURTHERMORE, I FOREVER RELEASE AND DISCHARGE, AND AGREE TO INDEMNIFY AND HOLD HARMLESS, the Released Parties from and in relation to all Damages that arise from or relate in any way to my participation in the Training or Services, other than Damages that arise solely from the gross negligence or intentional acts of any Released Parties. I FURTHER WARRANT AND CERTIFY that I have no health conditions or defects that would prevent me from participating safely in the Training or Services, that I have taken every reasonable act necessary to make this warranty and certification in relation to such participation, and that I am otherwise sufficiently fit and healthy to so participate.

I WARRANT AND UNDERSTAND that it is my sole and personal responsibility to obtain insurance to compensate for any and all Damages which might arise from my participation in the Training or Services, and furthermore agree to look solely to such insurance to cover such Damages, regardless of fault, and waive all rights of subrogation on behalf of any and all Released Parties which may now or ever exist as a result of such insurance.

I agree that I will be solely responsible for any Damages I, my guests, agents or invitees cause, including but not limited to any equipment or personnel and any hotel property or personnel, and will indemnify and defend API and Released Parties in connection with any Damages and other obligations directly or indirectly arising out of or related to any act or omission by me, my guests, agents or invitees.

IN ANY CASE, THE CUMULATIVE LIABILITY OF ALL RELEASED PARTIES RELATING TO ANY SERVICES OR TRAINING PROVIDED AND THIS AGREEMENT WILL BE LIMITED TO THE AMOUNT ACTUALLY PAID BY ME TO ANY OF THE RELEASED PARTIES DURING THE PERIOD THAT IS ONE (1) YEAR PRIOR TO THE DATE OF THE CAUSE OF ACTION BETWEEN THE LITIGANTS, MINUS ANY AMOUNTS PREVIOUSLY PAID BY ANY OF THE RELEASED PARTIES FOR ANY PRIOR LIABILITY. THE RELEASED PARTIES’ LIMITATION OF LIABILITY IS CUMULATIVE WITH ALL AMOUNTS PAID TO ANY RELEASED PARTIES BEING AGGREGATED TO DETERMINE SATISFACTION OF THE LIMIT AND APPLIES TO ALL CAUSES OF ACTION IN THE AGGREGATE (WHETHER IN TORT, CONTRACT OR OTHERWISE). I RELEASE THE RELEASED PARTIES FROM ALL OBLIGATIONS, LIABILITY, CLAIMS OR DEMANDS IN EXCESS OF THE LIMITATION.

If any provision of this Release shall be adjudged illegal, invalid or unenforceable, the balance of the Release shall remain in full force and effect. This Release shall be construed and governed under the state in which the EXOS facility is located. Any action or lawsuit arising out of or related to Training, Services, and/or this Release shall be exclusively brought in state or federal courts located in the county in which the EXOS facility is located.

I have read this Release, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily. I acknowledge that I have received valuable consideration in relation to my execution of this Release, which I understand to be a prerequisite to my receipt of Services. Finally, I understand that this Release shall be of full force and effect as to any and all Services and Training I receive from the Released Parties, without regard to the date or timing of such Services or Training.

Athlete Print Name:

Guardian Print Name:
Parent or Guardian Signature:

Clear

(draw your signature)

Date:

PUBLICITY WAIVER AND RELEASE

EXOS and its affiliates, representatives, licensees, successors and assigns (collectively, the “Company”), desires to use and publicize the name, likeness, and other personal characteristics and private information of the undersigned (“I,” “me,” or “my”) for advertising, promotion, and other commercial and business purposes. In exchange for the intangible value I will gain by participating in Company's publicity programs and other good and valuable consideration, the receipt and sufficiency of which I hereby acknowledge, I voluntarily give Company my permission for such use and publicity for such purposes, according to the terms and conditions set forth in this Publicity Waiver and Release (the “Agreement”).

I hereby irrevocably permit, authorize, grant, and license Company and its a respective licensees, advertising agencies, promotion agencies, and fulfillment agencies, and the employees, officers, directors, and agents of each and all of them (collectively, the “Authorized Persons”), the rights to display, publicly perform, exhibit, transmit, broadcast, reproduce, record, photograph, digitize, modify, alter, edit, adapt, create derivative works, exploit, sell, rent, license, otherwise use, and permit others to use my right of publicity and privacy in and to my name, image, likeness, appearance, persona, voice, professional and personal biographical information, signature, and other personal characteristics and private information, and all materials created by or on behalf of Company that incorporate any of the foregoing (collectively, the “Materials”) in perpetuity throughout the universe in any medium or format whatsoever now existing or hereafter created, including but not limited to, in and on print publications, television and radio broadcasts, display, point-of-sale, and other advertising and promotional materials, press releases, the internet and other digital transmission or delivery methods, mobile applications, on any platform and for any purpose, including but not limited to advertising, public relations, publicity, packaging, and promotion of Company and its affiliates and their businesses, products, and services, without further consent from or royalty, payment, or other compensation to me.

Company shall be the exclusive owner of all rights, including copyright, in the Materials. I hereby irrevocably transfer, assign, and otherwise convey to Company my entire right, title, and interest, if any, in and to the Materials and all copyrights and other intellectual property rights in the Materials arising in any jurisdiction throughout the universe in perpetuity, including all registration, renewal, and reversion rights, and the right to sue to enforce such copyrights against infringers. I acknowledge and agree that I have no right to review or approve Materials before they are used by Company, and that Company has no liability to me for any editing or alteration of the Materials or for any distortion or other effects resulting from Company's editing, alteration, or use of the Materials, or Company's presentation of me. Any credit or other acknowledgment of me, if any, shall be determined by Company in Company's sole discretion. Company has no obligation to create or use the Materials or to exercise any rights given by this Agreement.

To the fullest extent permitted by applicable law, I hereby irrevocably waive all legal and equitable rights relating to all liabilities, claims, demands, actions, suits, damages, and expenses, including but not limited to claims for copyright or trademark infringement, infringement of moral rights, libel, defamation, invasion of any rights of privacy (including intrusion, false light, public disclosure of private facts, and misappropriation of name or likeness), violation of rights of publicity, physical or emotional injury or distress, or any similar claim or cause of action in tort, contract, or any other legal theory, now known or hereafter known in any jurisdiction throughout the world (collectively, the “Claims”), arising directly or indirectly from the Authorized Persons' exercise of their rights under this Agreement or the production, exhibition, exploitation, advertising, promotion, or other use of the Materials, and I hereby covenant not to make or bring any such Claims against any Authorized Persons and forever release and discharge the Authorized Persons from liability under such Claims. I understand that Company is relying on this Agreement and will incur significant expense in reliance on this Agreement, and I agree that this Agreement cannot be terminated, rescinded, or modified, in whole or in part.

I represent and warrant to Company that I am at least eighteen (18) years of age (or if not, that my legal guardian will sign on my behalf), and I have full right, power, and authority to enter into this Agreement and grant the rights hereunder. I further represent and warrant to Company that I will provide only true and correct statements and other information in connection with this Agreement, and the Authorized Persons' use of the Materials and the rights and license granted hereunder do not, and will not, violate any right (including without limitation copyright, trademark, trade secret, right to privacy, or right of publicity) of, or conflict with or violate any contract with or commitment made to, any person or entity, and that no consent or authorization from, or any payment to, any third party is required in connection herewith. I agree to indemnify and hold harmless the Authorized Persons from and against all Claims by third parties resulting from my breach or alleged breach of this Agreement or any of the foregoing representations and warranties.

This Agreement constitutes the sole and entire agreement of the parties with respect to the subject matter contained herein and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral, with respect to such subject matter. I have not relied on any statement, representation, warranty, or agreement of Company or of any other person on Company's behalf, including any representations, warranties, or agreements arising from statute or otherwise in law, except for the representations, warranties, or agreements expressly contained in this Agreement. If any term or provision of this Agreement is invalid, illegal, or unenforceable in any jurisdiction, such invalidity, illegality, or unenforceability will not affect any other term or provision of this Agreement or invalidate or render unenforceable such term or provision in any other jurisdiction. Company may assign this Agreement and its rights hereunder, in whole or in part, to any party. This Agreement is binding on and inures to my benefit and the benefit of Company and our respective heirs, executors, administrators, legal representatives, successors, and permitted assigns. All matters arising out of or relating to this Agreement shall be governed by and construed in accordance with the internal laws of the State of Arizona without giving effect to any choice or conflict of law provision or rule (whether of the State of Arizona or any other jurisdiction). Any controversy, dispute or claim arising out of or relating to this Agreement, or any breach thereof, shall be settled by binding arbitration in accordance with the rules of the American Arbitration Association then in effect and judgment upon such award rendered by the arbitrator may entered in any court having jurisdiction thereof, and the parties hereto consent to the jurisdiction of the federal and state courts located in Arizona for this purpose. The arbitration shall be held by a single arbitrator in the Phoenix, Arizona area. Parties shall bear their own attorneys’ fees and costs, though the prevailing party may seek its reasonable outside attorneys’ fees expended.

BY SIGNING, I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD ALL OF THE TERMS OF THIS AGREEMENT AND THAT I AM VOLUNTARILY GIVING UP CERTAIN LEGAL RIGHTS, INCLUDING, WITHOUT LIMITATION, MY RIGHT TO SUE THE COMPANY.

If individual is under 18 years of age: I represent and warrant that I am the parent or guardian of the minor whose name appears above. I acknowledge that I have read the foregoing Agreement and am familiar with each and all of the terms contained therein, I am satisfied that the Agreement is fair and equitable, and I hereby give my express consent to its execution by my child/ward and will not revoke my consent at any time. I hereby fully and unconditionally guarantee the performance of my child's/ward’s obligations and the grant of rights in and to the results and proceeds of my child's/ward’s activities as set forth above.

Athlete Print Name:

Guardian Print Name:
Parent or Guardian Signature:

Clear

(draw your signature)

Date:

INTERNAL HEALTH INFORMATION COMMUNICATION RELEASE

NAME: <CHILDFIRSTNAME> <CHILDLASTNAME>
ADDRESS:
DOB: <CHILDBIRTHDAY>
TELEPHONE NUMBER:

NAME: <CHILDFIRSTNAME> <CHILDLASTNAME>
ADDRESS:
DOB: <CHILDBIRTHDAY>
TELEPHONE NUMBER:

NAME: <CHILDFIRSTNAME> <CHILDLASTNAME>
ADDRESS:
DOB: <CHILDBIRTHDAY>
TELEPHONE NUMBER:

NAME: <CHILDFIRSTNAME> <CHILDLASTNAME>
ADDRESS:
DOB: <CHILDBIRTHDAY>
TELEPHONE NUMBER:

NAME: <CHILDFIRSTNAME> <CHILDLASTNAME>
ADDRESS:
DOB: <CHILDBIRTHDAY>
TELEPHONE NUMBER:

NAME: <CHILDFIRSTNAME> <CHILDLASTNAME>
ADDRESS:
DOB: <CHILDBIRTHDAY>
TELEPHONE NUMBER:

NAME: <CHILDFIRSTNAME> <CHILDLASTNAME>
ADDRESS:
DOB: <CHILDBIRTHDAY>
TELEPHONE NUMBER:

NAME: <CHILDFIRSTNAME> <CHILDLASTNAME>
ADDRESS:
DOB: <CHILDBIRTHDAY>
TELEPHONE NUMBER:

NAME: <CHILDFIRSTNAME> <CHILDLASTNAME>
ADDRESS:
DOB: <CHILDBIRTHDAY>
TELEPHONE NUMBER:

NAME: <CHILDFIRSTNAME> <CHILDLASTNAME>
ADDRESS:
DOB: <CHILDBIRTHDAY>
TELEPHONE NUMBER:

I am an individual that has enrolled in a health, wellness and welfare program (“Program”) established by EXOS. As a participant in such Program, I hereby authorize use and/or disclosure of protected health information about me, my care and my treatment, as described below.

1. I hereby authorize EXOS to receive, use and disclose protected health information about me in connection with the administration of the Program and/or the provision of physical therapy, training, and other health care services to me pursuant to the Program.

2. I hereby authorize my EXOS physical therapists, trainers, and any other health care providers to disclose all protected health information about me to other EXOS employees.

3. I hereby authorize the disclosure of my full and complete medical records, including but not limited to patient histories, office notes, test results, radiology studies, images, and reports, referrals, consults, billing records, statement or charges, amounts paid and by whom and balances owed, insurance records, and records sent to you by other health care providers.

4. By initialing here: : Initial Here: I understand that the information about me which is released may include the following:

● Diagnosis and/or treatment of mental health conditions
● Diagnosis and/or treatment for alcohol and/or drug abuse;
● Diagnosis and/or treatment related to HIV or other communicable diseases.

5. I understand that the information used or disclosed may be subject to re-disclosure by the person or class of persons or facility receiving it, and would then no longer be protected by federal privacy regulations.

6. I may revoke this authorization at any time by notifying the providing organization in writing of my desire to revoke it. However, I understand that any action already taken in reliance on this authorization cannot be reversed, and my revocation will not affect those actions.

7. This authorization will expire five years from the date of this Authorization.

8. Please note that a copy of this authorization may serve in place of the original.

Athlete Print Name:

Guardian Print Name:
Parent or Guardian Signature:

Clear

(draw your signature)

Date:

ADDITIONAL SERVICES – PRODUCT

Description. EXOS and its subsidiaries and affiliates may make available to you software owned by EXOS and its subsidiaries and affiliates and/or third-party software (collectively, the “Program”) that is directed towards the evaluation and enhancement of four attributes (“Attributes”) of your athletic performance: Mindset, Nutrition, Movement, and Recovery. The Program will consider different data points for each such Attribute.

Process. The Program requires the disclosure of your personal data (“Data”) to EXOS and its subsidiaries and affiliates and/or to those of EXOS’ suppliers and business partners (“Third Party”). As a condition of using the Program, you are required to agree to (i) EXOS’s then-current “Terms of Service” and “Privacy Policy”, (ii) Third Party’s then-current “Terms of Service” and “Privacy Policy”, and/or (iii) any supplemental terms thereto (collectively, the “Program Terms”), as applicable. In all situations, including that in which EXOS is entering your Data into the Program, all your such Data shall be subject to the applicable Program Terms.

Reports. Based on the processing of Data by the Program, EXOS may provide you with a written report of the Program’s assessment of your status with respect to each of the Attributes (“Report”). Such Report is not, and shall not be deemed, medical advice, but shall provide certain recommendations to enhance your progress with respect to the corresponding Attributes.

By checking, you represent that you have read, understood, and assent to the applicable Program Terms with respect to the software owned by EXOS and/or third-party software listed, which you may utilize or access at your applicable facility, on behalf of yourself or your minor:

BridgeAthletic - Movement prescription platform that provides strength program delivery and tracking.
- Terms of Use: https://www.bridgeathletic.com/terms-of-use-agreement
- Privacy Policy: https://www.bridgeathletic.com/privacy-policy
DariMotion - 3D motion capture biomechanics hardware and software.
- Terms of Use: https://www.darimotion.com/termsandconditions
- Privacy Policy: https://www.darimotion.com/privacypolicy
DexaFit - Software platform used to supply physician pre
- Terms of Use: https://www.dexafit.com/terms
- Privacy Policy: https://www.dexafit.com/privacy
Hologic - DEXA scan hardware & software required to perform testing & shares data with Kitman Labs & DexaFit.
- Terms of Use: https://www.hologic.com/terms-conditions
- Privacy Policy: https://www.hologic.com/privacy-policy
Ixcela - Blood spot diagnostic test that assesses gut biome.
- Terms of Use: https://ixcela.com/terms-of-use/
- Privacy Policy: https://ixcela.com/privacy-policy/
Keiser - Strength equipment with embedded data capture.
- Terms of Use: https://www.keiser.com/pages/keiser-terms-conditions
- Privacy Policy: https://www.keiser.com/privacy-policy#:~:text=Keiser%20Corporation%20does%20not%20sell,disclosure%20of%20your%20personal%20information
Kitman Labs - Athlete management system that aggregates and analyzes data and provides internal and external communication channels.
- Terms of Use: https://www.kitmanlabs.com/acceptable-use-policy/
- Privacy Policy: https://www.kitmanlabs.com/privacy-policy/
MindBodyOnline - Member management platform that intakes registration information through Waiverking and processes payment.
- Terms of Use: https://company.mindbodyonline.com/legal/terms-of-service
- Privacy Policy: https://company.mindbodyonline.com/legal/privacy-policy
Push Strength - Sensor that assesses bar and arm speed to provide velocity-based training data.
- Terms of Use: https://www.trainwithpush.com/legal
- Privacy Policy: https://intercom.help/pushcenter/en/articles/1531253-privacy-policy
The Feed - Nutrition supplement online retailer.
- Terms of Use: https://thefeed.com/pages/terms
- Privacy Policy: https://thefeed.com/pages/privacy
Vald Performance - Suite of diagnostic hardware (forceplates and muscle strength testing) and software.
- Privacy Policy: https://valdperformance.com/privacy-policy/
Waiverking - Registration processing platform.
- Terms of Use: https://www.waiverking.com/terms-services
- Privacy Policy: https://www.waiverking.com/privacy-policy
Woodway - Cardiovascular training equipment with embedded data capture.
- Terms of Use: https://www.woodway.com/terms-conditions/
- Privacy Policy: https://www.woodway.com/privacy-policy/
ZoneIn - Nutrition prescription delivery and meal ordering platform.
- Terms of Use: https://www.getzonein.com/terms-of-service
- Privacy Policy: https://www.getzonein.com/privacy-policy

AGREED TO:

Athlete Print Name:

Guardian Print Name:
Parent or Guardian Signature:

Clear

(draw your signature)

Date:

PERFORMANCE PHYSICAL THERAPY SERVICES

CONSENT TO TREAT

I understand that I may require some form of rehabilitative or preventative treatment during my stay at EXOS. I understand that care will be provided by licensed physical therapists and licensed/certified athletic trainers. I also could be referred for rehabilitative treatment to EXOS via a self-referral or referral from a physician. In such cases, an individual treatment plan will be described for me. I understand that I have the right to ask and have any questions answered prior to receiving any treatment, including any risks or alternatives to the treatment plan that has been prescribed by my physician and/or recommended by my physical therapist. By signing this agreement, I consent to have EXOS provide treatment and care as necessary for rehabilitation of an injury or injury prevention.

The statements are true and complete to the best of my knowledge. I understand, fully, the payment policy and billing procedures of EXOS I hereby authorize EXOS to furnish my insurance company(s), privately contracted medical billing provider (WebPT), attorney, or legal representative all information, which said parties might request concerning my present illness or injury. I hereby assign EXOS all money to which I am entitled for medical expenses related to the service reported herein, but not to exceed my indebtedness to EXOS I certify by my signature that I have read and agree to this information.

CANCELLATION POLICY

To cancel or change your appointment without a fee, please call or email your physical therapist at least 24 hours in advance. In the event of a late cancellation or if you do not show for your scheduled appointment, you will be charged with a $25 fee for the first occurrence.

The $25 fee will be applied to the credit card on file for the first offense. For a subsequent late cancellation/no show, a $50 fee will be applied to the credit card. For the 3rd late cancellation/no show and each subsequent one, a fee of $144/hour, for each of your scheduled appointment will be applied to the credit card.

In the event of a legitimate excuse, such as a car accident, flat tire, medical emergency, etc., evidence supporting the excuse such as a police report, receipt, or doctor’s note documenting the excuse will be accepted in lieu of payment. Notify your therapist immediately (within 24 hours) if such documentation exists.

DRY NEEDLING CONSENT

What is Dry Needling?

Dry needling is a form of therapy in which fine needles are inserted into myofascial trigger points (painful knots in muscles), tendons, ligaments, or near nerves in order to stimulate a healing response in painful musculoskeletal conditions. Dry needling is not acupuncture or Oriental Medicine; that is, it does not have the purpose of altering the flow of energy ("Qi'1 along traditional Chinese meridians for the treatment of diseases. In fact, dry needling is a modern, science-based intervention for the treatment of pain and dysfunction in musculoskeletal conditions such as neck pain, shoulder impingement, tennis elbow, carpal tunnel syndrome, headaches, knee pain, shin splints, plantar fasciitis, or low-back pain.

Is Dry Needling safe?

Drowsiness, tiredness or dizziness occurs after treatment in a small number of patients (1-3%) and if affected, you are advised not to drive. Minor bleeding or bruising occurs after dry needling in 15- 20% of treatments and is considered normal. Temporary pain during dry needling occurs in 60- 70% of treatments. Existing symptoms can get worse after treatment (less than 3% of patients); however, this is not necessarily a "bad" sign. Fainting can occur in certain patients (0.3%), particularly at the first treatment session when needling the head or neck regions. Dry needling is very safe; however, serious side effects can occur in less than 1 per 10,000 (less than 0.01%) treatments. The most common serious side effect from dry needling is pneumothorax (lung collapse due to air inside the chest wall). .The symptoms of dry needling-induced pneumothorax commonly do not occur until after the treatment session, sometimes taking several hours to develop. The signs and symptoms of a pneumothorax may include shortness of breath on exertion, increased breathing rate, chest pain, a dry cough, bluish discoloration of the skin, or excessive sweating. If such signs and/or symptoms occur, you should immediately contact your physical therapist or physician. Nerves or blood vessels may be damaged from dry needling which can result in pain, numbness or tingling; however, this is a very rare event and is usually temporary.

Damage to internal organs has been reported in the medical literature following needling; however, these are extremely rare events (1 in 200,000).

Is there anything your practitioner needs to know?

▪ Have you ever fainted or experienced a seizure?
YES    NO

▪ Do you have a pacemaker or any other electrical implant?
YES    NO

▪ Are you currently taking anticoagulants (blood-thinners e.g. aspirin, warfarin, coumadin)?
YES    NO

▪ Are you currently taking antibiotics for an infection?
YES    NO

▪ Do you have a damaged heart valve, metal prosthesis or other risk of infection?
YES    NO

▪ Are you pregnant or actively trying for a pregnancy?
YES    NO

▪ Do you suffer from metal allergies?
YES    NO

▪ Are you a diabetic or do you suffer from impaired wound healing?
YES    NO

▪ Do you have hepatitis B, hepatitis C, HIV, or any other infectious disease?
YES    NO

▪ Have you eaten in the last two hours?
YES    NO

Single-use, disposable needles are used in this clinic.

STATEMENT OF CONSENT

I confirm that I have read and understand the above information, and I consent to having dry needling treatments. I understand that I can refuse treatment at any time.

Athlete Print Name:

Guardian Print Name:
Parent or Guardian Signature:

Clear

(draw your signature)

Date:

MEDICAL HISTORY FORM

Date :
Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
DOB: <CHILDBIRTHDAY>	Age: <CHILDAGE>

Date :
Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
DOB: <CHILDBIRTHDAY>	Age: <CHILDAGE>

Date :
Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
DOB: <CHILDBIRTHDAY>	Age: <CHILDAGE>

Date :
Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
DOB: <CHILDBIRTHDAY>	Age: <CHILDAGE>

Date :
Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
DOB: <CHILDBIRTHDAY>	Age: <CHILDAGE>

Date :
Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
DOB: <CHILDBIRTHDAY>	Age: <CHILDAGE>

Date :
Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
DOB: <CHILDBIRTHDAY>	Age: <CHILDAGE>

Date :
Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
DOB: <CHILDBIRTHDAY>	Age: <CHILDAGE>

Date :
Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
DOB: <CHILDBIRTHDAY>	Age: <CHILDAGE>

Date :
Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
DOB: <CHILDBIRTHDAY>	Age: <CHILDAGE>

*Please fill out the following health information honestly and thoroughly, to the best of your knowledge.

Do you now, or have you in the past, had any of the following (please also consider during and/or after exercise):

AIDS/HIV	Yes No
Asthma	Yes No
Cancer	Yes No
Chest Pain/Angina	Yes No
Concussion	Yes No
Diabetes	Yes No
Dizziness/Fainting	Yes No
Heart Attack	Yes No
Heart Related Illness	Yes No
High Blood Pressure	Yes No
Respiratory Issues	Yes No
Sickle Cell	Yes No
Stroke	Yes No
Ever diagnosed with Cardiac related problems? Yes No

Please list any other health issues that have affected you in the past, or are currently affecting you, that were not listed above. Including Allergies, Medications: * (type N/A if none apply)

INJURY HISTORY

Injury #1

Location:

Type of Injury:

Date of Onset:

Treatment:

Current Status:

Injury #2

Location:

Type of Injury:

Date of Onset:

Treatment:

Current Status:

Injury #3

Location:

Type of Injury:

Date of Onset:

Treatment:

Current Status:

The statements above are true and complete to the best of my knowledge.

Athlete Print Name:

Guardian Print Name:
Parent or Guardian Signature:

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ACKNOWLEDGEMENT OF RECEIPT OF EXOS’S NOTICE OF PRIVACY PRACTICES

By signing this document in the space provided below, you hereby acknowledge and agree to the terms set forth in the EXOS Terms of Service and Privacy Policy. The EXOS Terms of Service can be found at legal-docs.teamexos.com/terms-of-service; the EXOS Privacy Policy can be found at legal-docs.teamexos.com/privacy-policy. Further, you agree that any information you have provided will be governed in accordance with the terms set forth in the EXOS Privacy Policy. You also acknowledge that you have had an opportunity to review both the EXOS Terms of Service and Privacy Policy, and have the right to request a printed copy of either such document at any time.

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(Required if Patient is a minor or an adult who is unable to sign this form)

Relation to Client:

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*I opt-in to receiving information from Exos via email and text.

Parent or Legal Guardian Information:

First Name:	Last Name:	Birth Date:
Address:	City:	State:
		Country:
Zip:	Email:	Phone:

Relationship to minor:

Full Name and Birth Date of family members under the age of 18

#1	First Name:	Last Name:	Birth Date:
#2	First Name:	Last Name:	Birth Date:
#3	First Name:	Last Name:	Birth Date:
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Our Privacy Policy

PLEASE NOTE THAT WAIVERKING, INC.’S (“WaiverKing”) PRIVACY POLICY HAS CHANGED EFFECTIVE May 25th, 2018.

You acknowledge that this privacy policy is a part of our website’s Terms of Service, and by accessing or using our website, you agree to be bound by all of its terms and conditions. IF YOU DO NOT AGREE TO THESE TERMS, AS UPDATED, PLEASE IMMEDIATELY STOP ACCESSING THE WEBSITE.

This document explains how we use your personal data.

When you sign up to use this service provider’s services, you do so through software provided by us, WaiverKing.

We are committed to ensuring the privacy of all users of our software and services and other visitors to our website. In this policy we explain how we hold, process and retain your personal data.

In respect to the account data, waiver data, and payment data (as defined below) that you provide to us, we are acting as a data processor on behalf of the service provider, who will be acting as the data controller in respect to such data. We will never store or control this data. You should direct any requests or queries you have regarding this data to the data controller, your service provider.

1. How we use your personal data

1.1. This section provides you with information about:

a) what personal data we hold and process;

b) in respect of personal data that we did not collect from you directly, where we obtained that data from, and what types of data we have collected;

c) the purposes for which we may process your personal data; and

d) the legal grounds on which we process your data.

Members and end users of our services

1.2. Account data. We may process information about you that you provide to us when you first sign up with a service provider ("account data"). This account data may include your name, address, telephone number, email address, date of birth, gender, employment details, and a photograph of you. We may use this data to create your account with the service provider when you sign up. This account data may be updated each time you complete a document through our software. We do not process your account data in any other way, or have access to it in any way.

The legal basis for this processing is our legitimate interests in providing our services to our clients, and ensuring that your account is updated each time that you complete a document through our software.

1.3. Waiver data. If you are using our software in order to sign documents such as a waiver, health form, contract, or questionnaire, we may process information that you put into such documents (“waiver data”). This waiver data may include your name, signature, date of birth, email address, information about your health and medical history, and any other information that you are required or requested to put into the document.

Once you have completed the document, we will process it, convert the document into a different format, and send it to your account with the service provider in order for it to be stored. We will never store your data permanently on our systems (although it may be stored in your account with your service provider).

The purpose for our processing your data in this way is to maintain and administer a complete and accurate record of the documents that you have signed and completed for your service provider. The legal basis for our processing your waiver data (to the extent that such waiver data does not class as a special category of personal data), will be our legitimate interests in providing our services to our clients who have asked you to complete the document in question, in order to ensure that a complete and accurate record of your signing and completing the documents is maintained and administered.

1.4. Sensitive Personal Data. During the course of using our software and services and providing us with information in order for us to provide our services to you, you may provide us with sensitive information about yourself (“sensitive data”). This sensitive data may include your health and medical history. We may use this data for providing our services to you. However, we will only process this sensitive data if you consent to us doing so.

[The consent to use this information needs to be provided by the parent for children under the age of 13. Anyone over the age of 13 can provide consent for use of their data under GDPR]

We comply with the requirements of the Children’s Online Privacy Protection Act. You must be at least 18 years old to have our permission to use the WaiverKing website. If you are between the ages of 13 and 17, or under the age of majority where you live, you represent that your legal guardian has reviewed and agreed to this privacy policy.

Other processing that we may carry out

1.5. Website data. We may process data about your use of our website and services ("website data"). The website data may include your IP address, geographical location, browser type and version, operating system, referral source, length of visit, page views and website navigation paths, as well as information about the timing, frequency and pattern of your service use. The source of the website data is our analytics tracking system. This website data may be processed for the purposes of analyzing the use of the website and services.

The legal basis for this processing is our legitimate interests, namely monitoring and improving our website and services.

We may also process this data for the purposes of diagnosing any issues we detect in relation to the use of our products or services. This data may be collected by our error-tracking software which is provided by Rollbar. We always try to ensure that any such data is anonymized so that you cannot be identified before it is stored in our records.

The legal basis for this processing is our legitimate interests in monitoring and improving our products and services.

1.6. Enquiry data. We may process information contained in any enquiry you submit to us regarding our products or services ("enquiry data"). The enquiry data may be processed for the purposes of offering, marketing and selling relevant products and/or services to you.

The legal basis for this processing is our legitimate interests, namely dealing with and responding to your enquiry appropriately.

1.7. Notification data. We may process information that you provide to us for the purpose of subscribing to our blog and press releases ("notification data"). The notification data may be processed for the purposes of sending you newsletters.

Where you are a corporate customer, the legal basis for this processing is our legitimate interests, namely the marketing of relevant products and services to you.

1.8. Correspondence data. We may process information contained in or relating to any communication that you send to us ("correspondence data"). The correspondence data may include the communication content and metadata associated with the communication. Our website will generate the metadata associated with communications made using the website contact forms. The correspondence data may be processed for the purposes of communicating with you and record-keeping.

The legal basis for this processing is our legitimate interests, namely the proper administration of our website and business and communications with users.

1.9. Payment data. We do not process payment information relating to goods and services that you purchase from the service provider. However, we do capture certain data relating to your payments and use them to update your account with the service provider ("payment data"). The payment data may include your contact details, your card details and the transaction details. The payment data may be processed for the purposes of updating your account with the service provider. The legal basis for this processing is our legitimate interests, namely our interest in the proper administration of our software and ensuring your account with the service provider is updated.

1.10. Other processing activities. In addition to the specific purposes for which we may process your personal data set out above, we may also process any of your personal data where such processing is necessary for compliance with a legal obligation to which we are subject, or in order to protect your vital interests or the vital interests of another natural person.

2. Providing your personal data to others

2.1. To our clients and partner service providers. The only third parties that we will disclose your personal data to are our clients (your service provider) who is the data controller in respect to the account data, waiver data, and payment data that we collect about you, and MINDBODY Inc. (“MINDBODY”), who provide software services to service providers in conjunction with the WaiverKing software. Your accounts are created by WaiverKing in the MINDBODY software on behalf of our clients.

2.2. Our insurers/professional advisers. We may disclose your personal data to our insurers, legal counsel, and/or professional advisers insofar as reasonably necessary for the purposes of obtaining and maintaining insurance coverage, managing risks, obtaining professional advice and managing legal disputes.

2.3. Where we provide your personal data to any third party. Where we share your personal data with any of the third parties referred to above, we will ensure this processing is protected by appropriate safeguards including a suitable data processing agreement with that third party.

2.4. To comply with legal obligations. In addition to the specific disclosures of personal data detailed above, we may also disclose your personal data where such disclosure is necessary for compliance with a legal obligation we have to comply with, or in order to protect your vital interests or the vital interests of another individual. This may include disclosing your personal data in response to lawful requests by public authorities, including to meet national security or law enforcement requirements.

2.5. We take reasonable and appropriate steps to ensure that third-party agents and service providers process your personal data in accordance with our Privacy Shield obligations and to stop and remediate any unauthorized processing. Under certain circumstances and pursuant to applicable laws, we may remain liable for the acts of our third-party agents or service providers who perform services on our behalf for their handling of your personal data that we transfer to them.

3. Transfers of your personal data outside of the European Economic Area

As further detailed below, we may transfer your personal data to our servers based in the US, as we are part of the Privacy Shield. Otherwise, where your personal data is transferred outside of the EEA, we will ensure that either (a) The European Commission has made an "adequacy decision" with respect to the data protection laws of the country to which it is transferred, or (b) we have entered into a suitable data processing agreement with the third party situated in that country to ensure the adequate protection of your data. In all cases, transfers outside of the EEA will be protected by appropriate safeguards.

4. Retaining and deleting personal data

4.1. Personal data that we process for any purpose or purposes shall not be kept for longer than is necessary for that purpose or those purposes. Details about members of our clients (your service provider) and end users of our services, including the account data, waiver data and sensitive personal data, will not be stored by WaiverKing.

4.2. Unless we contact you and obtain your consent for us to retain your personal data for a longer period, we will retain and delete your personal data as follows:

a) Website data will be retained for 12 months following the date of our last contact or dealing with you, at the end of which period it will be deleted from our systems.

b) Enquiry data will be retained for 12 months following the date of our last contact or dealing with you, at the end of which period it will be deleted from our systems.

c) Notification data (other than Notification data that is also Contact data) will be retained for 12 months following the date of our last contact or dealing with you, at the end of which period it will be deleted from our systems.

d) Correspondence data will be retained for 12 months following the date of our last contact or dealing with you, at the end of which period it will be deleted from our systems.

4.3. We may retain your personal data where such retention is advisory and/or necessary for compliance with a legal obligation to which we are subject (such as with regard to applicable statutes of limitations, litigation or regulatory investigations), or in order to protect your vital interests or the vital interests of another natural person.

5. Your rights

5.1. You may instruct us to provide you with any personal information we hold about you; provision of such information will be subject to:

a) your request not being found to be unfounded or excessive, in which case a charge may apply; and

b) the supply of appropriate evidence of your identity (for this purpose, we will usually accept a notarized photocopy of your driver’s license and/or passport and an original copy of a utility bill showing your current address).

5.2. We may withhold personal information that you request to the extent permitted by law.

5.3. You may instruct us at any time not to process your personal information for marketing purposes.

5.4. In practice, you will usually expressly agree in advance to our use of your personal information for marketing purposes, or we will provide you with an opportunity to opt out of the use of your personal information for marketing purposes.

5.5. Your right to access your data. You have the right to ask us to confirm whether or not we process your personal data and, to have access to the personal data, and any additional information. That additional information includes the purposes for which we process your data, the categories of personal data we hold and the recipients of that personal data. You may request a copy of your personal data. The first copy will be provided free of charge, but we may charge a reasonable fee for additional copies.

5.6. Your right to correct. If we hold any inaccurate personal data about you, you have the right to have these inaccuracies corrected. Where necessary for the purposes of the processing, you also have the right to have any incomplete personal data about you completed.

5.7. Your right to erasure. In certain circumstances you have the right to have personal data that we hold about you erased. This will be done without undue delay. These circumstances include the following: (1) it is no longer necessary for us to hold those personal data in relation to the purposes for which they were originally collected or otherwise processed; (2) you withdraw your consent to any processing which requires consent; (3) the processing is for direct marketing purposes; and/or (4) the personal data have been unlawfully processed. However, there are certain general exclusions of the right to erasure, including where processing is necessary: for exercising the right of freedom of expression and information; for compliance with a legal obligation; or for establishing, exercising or defending legal claims.

5.8. Your right to restrict processing. In certain circumstances you have the right for the processing of your personal data to be restricted. These circumstances include the following: (1) you do not think that the personal data we hold about you is accurate; (2) your data is being processed unlawfully, but you do not want your data to be erased; (3) it is no longer necessary for us to hold your personal data for the purposes of our processing, but you still require that personal data in relation to a legal claim; and/or (4)you have objected to processing, and are waiting for that objection to be verified. Where processing has been restricted for one of these reasons, we may continue to store your personal data. However, we will only process it for other reasons: with your consent; in relation to a legal claim; for the protection of the rights of another natural or legal person; or for reasons of important public interest.

5.9. Your right to object to processing. You can object to us processing your personal data where our legal basis for the processing is that it is necessary for: the performance of a task carried out in the public interest, or in the exercise of any official authority vested in us; or the purposes of our legitimate interests or those of a third party. If you make an objection, we will stop processing your personal information unless we are able to: demonstrate compelling legitimate grounds for the processing, and that these legitimate grounds override your interests, rights and freedoms; or the processing is in relation to a legal claim.

5.10. Your right to object to direct marketing. You can object to us processing your personal data for direct marketing purposes. If you make an objection, we will stop processing your personal data for this purpose.

5.11. Your right to data portability. Where you have given us consent to process your personal data, or where we are processing your personal data for the performance of a contract, you have a legal right to receive a copy of the personal data we hold about you in a structured, commonly used and computer readable format. When a data request is made of us we will make available all applicable personal data to you in a computer readable format and will transmit your personal data to the appropriate third party pursuant to your instruction. We will not process your data in this way if we believe that it may pose a threat to the security of the data.

5.12. Your right to object for statistical purposes. You can object to us processing your personal data for statistical purposes on grounds relating to your particular situation, unless the processing is necessary for performing a task carried out for reasons of public interest.

5.13. Automated data processing. To the extent that the legal basis we are relying on for processing your personal data is consent, and where the processing is automated, you are entitled to receive your personal data from us in a structured, commonly used and computer-readable format. However, you may not have this right if it would adversely affect the rights and freedoms of others.

5.14. Complaints to a supervisory authority pursuant to the GDPR. If you think that our processing of your personal data infringes data protection laws, you can lodge a complaint with a supervisory authority responsible for data protection. You may do this in the EU member state of your habitual residence, your place of work or the place of the alleged infringement. This provision is only applicable if you are subject to the protections of the GDPR.

5.15. Complaints if you are not subject to the protections of the GDPR. If you think that our processing of your personal data infringes data protection laws you may contact us via email at privacy@waiverking.com or mail at: WaiverKing, Inc. 340 S Lemon Ave # 2018 Walnut, California 91789.

5.16. Right to withdraw consent. To the extent that the legal basis we are relying on for processing your personal data is consent, you are entitled to withdraw that consent at any time. Withdrawal will not affect the lawfulness of processing before the withdrawal.

5.17. Exercising your rights. You may exercise any of your rights in relation to your personal data by written notice to us in addition to the other methods specified above.

5.18. Point of Contact Data. PARAGRAPHS 5.1 – 5.17 SHALL NOT APPLY TO ACCOUNT DATA, WAIVER DATA, OR PAYMENT DATA OBTAINED OR PROCESSED BY WAIVERKING. IN RESPECT OF SUCH DATA:

a) WAIVERKING IS ACTING AS A PROCESSOR OF THAT DATA AND THE MAIN CONTRACTOR IS THE CONTROLLER;

b) YOU SHOULD CONTACT THE SERVICE PROVIDER TO EXERCISE THE RIGHTS SET OUT IN THIS PARAGRAPH 5

6. Links To Other Websites. Except as otherwise discussed in this privacy policy, this document only addresses the use and disclosure of information we collect from you. Other websites accessible through our website have their own privacy policies and data collection, use, and disclosure practices. Please consult each website’s privacy policy. We are not responsible for the policies or practices of third parties, including any third-party site or other products and services used in connection with WaiverKing’s services. The inclusion of a link does not imply endorsement of the linked site or service by us or by our affiliates.

We are not responsible for the collection, usage and disclosure policies and practices (including the data security practices) of other organizations, such as, Apple, Google, Microsoft, or any other operating system provider, wireless service provider or device manufacturer, including any personal data you disclose to other organizations through or in connection with WaiverKing’s services.

7. Security of Your Information. The security of personal data is a high priority at WaiverKing. We seek to use reasonable technical, administrative and physical safeguards to protect personal data within our organization. Unfortunately, no data transmission or storage system can be guaranteed to be 100% secure. As a result, while we strive to protect your personal data, you acknowledge that: (a) there are security and privacy limitations of the Internet which are beyond our control; (b) the security, integrity, and privacy of any and all information and data exchanged between you and us through the website cannot be guaranteed; and (c) any such information and data may be viewed or tampered with in transit by a third party.

8. IP Addresses and Cookies. Cookies are very small text files that are stored on your computer when you visit some websites.

We use cookies to help identify your computer, including where available, your IP address, operating system and browser type, for system administration so we can keep your activity secure, tailor your user experience and remember your preferences. This is statistical data and does not identify any individual. You are always free to decline our cookies if your browser permits, but some parts of our website may not work properly.

9. Your California Privacy Rights: Notice to California Customers and Opt-Out Information. Residents of the State of California, under certain provisions of the California Civil Code, have the right to request from companies conducting business in California a list of all third parties to which the company has disclosed certain personal data, as defined under California law, during the preceding year for third party direct marketing purposes. You are limited to one request per calendar year. In your request, you must supply appropriate evidence of your identity and attest to the fact that you are a California resident and provide a current California address for our response. You may request the information by writing to privacy@waiverking.com

Some web browsers incorporate a “Do Not Track” feature that signals to websites that you visit that you do not want to have your online activity tracked. California residents are entitled to know how WaiverKing, Inc. responds to “Do Not Track” signals. How browsers communicate the Do Not Track signal is not yet uniform, so a standard technological response has not yet been developed by the appropriate technology communities. For this reason, we do not respond to Do Not Track signals currently. To opt out of direct advertising on our website, please send a request to the address above. The effect of an opt-out will be to stop direct advertising, but it will still allow the collection of usage data for certain purposes (e.g., research, analytics, and internal online services operation purposes).

10. Privacy Shield Framework

10.1. WaiverKing Inc. complies with the EU-U.S. and Swiss-U.S. Privacy Shield Framework as set forth by the U.S. Department of Commerce regarding the collection, use, and retention of personal information transferred from the European Union and Switzerland to the United States. WaiverKing has certified to the Department of Commerce that it adheres to the Privacy Shield Principles. If there is any conflict between the terms in this privacy policy and the Privacy Shield Principles, the Privacy Shield Principles shall govern. To learn more about the Privacy Shield program, and to view our certification, please visit https://www.privacyshield.gov/

10.2. In compliance with the Privacy Shield Principles, WaiverKing commits to resolve complaints about our collection or use of your personal information. Any individual(s) with inquiries or complaints regarding our Privacy Shield policy should contact us at: privacy@waiverking.com

10.3. WaiverKing Inc. has further committed to refer unresolved Privacy Shield complaints to Judicial Arbitration and Mediation Services (JAMS), an alternative dispute resolution provider located in the United States. If you do not receive timely acknowledgment of your complaint from us, or if we have not addressed your complaint to your satisfaction, please visit https://www.jamsadr.com/eu-us-privacy-shield for more information or to file a complaint. The services of JAMS are provided at no cost to you. In certain situations, you may also have the right to pursue binding arbitration under the Privacy Shield Framework.

10.4. You may have the option to select binding arbitration for the resolution of your complaint under certain circumstances, provided you have taken the following steps: (1) raised your complaint directly with WaiverKing Inc. and provided us the opportunity to resolve the issue; (2) made use of the independent dispute resolution mechanism identified above; and (3) raised the issue through the relevant data protection authority and allowed the U.S. Department of Commerce an opportunity to resolve the complaint at no cost to you. For more information on binding arbitration, see U.S. Department of Commerce's Privacy Shield Framework: Annex I (Binding Arbitration).

10.5. For purposes of enforcing compliance with the Privacy Shield, WaiverKing is subject to the investigatory and enforcement authority of the U.S. Federal Trade Commission.

10.6. WaiverKing Inc. is controlled and operated by us from the United States. Except where you are a resident of a Member State of the EU, in which case paragraphs 2 and 3 above will apply, your personal data may be stored and processed in any country in which we engage service providers, and by using WaiverKing’s services you understand that your information may be transferred to countries outside of your country of residence, including the United States, which may have data protection rules that are different from those of your country. In certain circumstances, courts, law enforcement agencies, regulatory agencies or security authorities in those other countries may be entitled to access your personal data. Regardless of where your information is processed, we apply the same protections described in this policy.

11. Changes to the privacy policy. We reserve the right to change this policy at any time, without prior notice to you. Such changes, modifications, additions, or deletions shall be effective immediately upon notice thereof, which may be given by means including, but not limited to, issuing an e-mail to the e-mail address provided by you or posting the revised policy on this page. You acknowledge and agree that it is your responsibility to maintain a valid e-mail address and/or review the WaiverKing website and this policy periodically, and be aware of any modifications. Your continued use of the WaiverKing website after such modifications will constitute your: (a) acknowledgment of the modified policy; and (b) agreement to abide and be bound by the modified policy.

12. Our details

12.1. This website and software is owned and operated by WaiverKing Inc.

12.2. We are registered in the state of California under registration number C3518177, and our registered office is at 340 S Lemon Avenue, # 2018 Walnut, California 91789.

12.3. You can contact us:

a) by mail, using the postal address given above;

b) using our website contact form;

c) by telephone, on the contact number published on our website from time to time; or

d) by email, using the email address published on our website from time to time.

13. Data protection officer

Our data protection officer may be contacted via email: privacy@waiverking.com, or telephone: +1 (888) 211-6693.

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