Name *

First Name

Last Name

Waiver *

By participating in The Mother's Day Extravaganza, hosted by Recharged Performance Therapy, I hereby release Recharged Performance Therapy and its affiliates from any liability for personal injury, illness, or property damage incurred during the event. I grant Recharged Performance Therapy permission to use any media captured during the event for promotional and business purposes. I consent to the collection and use of my personal information for business purposes. All information will be handled per company policy and will not be shared outside of the company.

Yes, I agree to the above statement and choose to participate in the event