FAA Waiver Form In the event of an emergency, I give my permission to UNICUS Performance Training, LLC and its agents and employees, to secure all necessary and required medical treatment. I agree that I have the medical consent to participate in a physically active program based upon my current health status. I agree to indemnify and hold harmless UNICUS PERFORMANCE TRAINING, LLC, and its agents, officers, principals, and employees from and against any and all obligations, losses, damages, penalties, actions, judgments, suits, costs, expenses and distributions of any kind or nature which may result from participation in any manner in any UNICUS Performance Training programs. The undersigned hereby understands and assumes any and all risk with participation in UNICUS Performance Training, LLC.

* indicates required fields    *First Name:   *Last Name:   *Email:   *Phone:   *Are you currently taking medication? Please list: Yes No   *Do you have allergies?: Yes No   *Do you have a history of lung problems?: Yes No   *Do you have muscle, joint or back disorder that co: Yes No   *Do you have a chronic illness?: Yes No   *Please initial that all of the above is correct .:

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