Movement Screening Waiver & Release

The FARM: Functional Athletic Rehabilitation, LLC (The FARM) and it’s staff will perform movement assessment and exercise prescription based upon assessment findings only. No treatment or medical advice will be provided. By filling out this form you agree to the terms and release The FARM from any and all liabilities associated with participation in sports, exercises, or activities associated with this screen.

Parent Name

First Name

Last Name

Athlete Name

First Name

Last Name

Email

Phone

(###)

###

####