Name_________________________________
Address_______________________________
City, State, Zip________________________
Phone Day_____________________________
Phone Night___________________________
E-mail________________________________
Partner’s Name_________________________
Informed Consent and Waiver of Liability
I hereby affirm and warrant that I fully understand that the Maverick Athletic Club conducts programs of strenuous physical activity which involve risk of serious injury or property damage. In full knowledge and in consideration of my (our) participation in the use of the facilities, I hereby agree to accept all risk and do indemnify and hold harmless Maverick Athletic Club, its officers, directors and employees from any and all claims, damage, or liabilities, (including without limitation reasonable attorney’s fees) for personal injuries or loss, theft or damage of any nature whatsoever, arising out of or in any way connected with the use of the facilities by the undersigned, or any guest thereof, regardless of the cause of any such claim, damage or liability.

Signature_____________________Date_____