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Register HEART of a Warrior

Registration Form: “HEART of a Warrior”

Thank you in advance for your trust in allowing me and this “HEART of a Warrior” training to be a part of your personal and professional development journey.

To register for the “HEART of a Warrior” training course please complete all the details

on this form and click the “Register My Place” button.

Privacy: We never give your details to anyone for any reason.

Personal Details
Name*
First Last
Name you would like printed on your certificate*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Phone*
Email*
T Shirt Size*
Gender*
Food Restrictions
Organization, Business or School Name*
Your Role, Position, or Title*
Training Start Date*
Training Questionnaire
Please answer the following questions as completely as possible.

There is no right or wrong. Your answers will enable our trainers to maximize your experience. ALL answers remain confidential.
1. How have you applied what you learned in Leadership from the Heart to your life?*
2. What have been 3 challenges or obstacles in achieving success and happiness in your life since your Leadership from the Heart Training?*
3. What are 3 things that you would like to get out of this L2 - The Battle Training?*
4. What are your top three goals in the next 12 months?*
5. Who are you? And what do you stand for?*
BRANDON W JOHNSON, LLC

RELEASE OF LIABILITY AGREEMENT & WAIVER AND INFORMED CONSENT AGREEMENT

L2 – THE BATTLE

PLEASE REVIEW THE FOLLOWING IMPORTANT INFORMATION CONCERNING YOUR RISKS AND LIABILITIES CONNECTED WITH YOUR PARTICIPATION IN THIS PROGRAM.

THIS IS AN IMPORTANT LEGAL DOCUMENT.

This Release, Waiver, and Informed Consent Agreement (this “Agreement”) is entered into between you (as “Participant”) and, Brandon W Johnson, LLC. (“BWJ, LLC”). Participant voluntarily agrees to Participate in various events, including but not limited to, physically and mentally demanding, stressful and inherently dangerous activities, such as breaking through a wood board with Participant’s hand (collectively, the “Events”).

In consideration of (i) the acceptance by BWJ, LLC of Participant’s participation in the Events; (ii) Participant being permitted to use BWJ, LLC’s property, BWJ, LLC’s licensed areas; and (iii) Participant being permitted to observe or in any capacity participate in the Events, intending to be legally bound hereby, Participant, Participant’s personal representatives, Participant’s assigns, estate, and heirs acknowledge, agree, and represent the following:

Risks of Participation. Participant acknowledges that the Events are inherently risky and could result in injury. Participant understands that such risks are inherent in the Events, and while BWJ, LLC will take reasonable precautions to prevent harm to Participant, and Participant’s risks cannot be eliminated if Participant chooses to participate in the Events. Participant expressly agrees and promises to accept and assume all of the risks existing in the Events. Participant’s participation is purely voluntary and Participant chooses to participate in spite of the risks specifically set forth in this Agreement.

Medical Insurance. Participant agrees to bear the costs of any such injury or damage up to and beyond the limits of Participant’s insurance coverage, and acknowledges, agrees, and understands that BWJ, LLC will have no liability whatsoever for any injury or damage caused and/or suffered by Participant.

Injuries & Medical Problems. Participant further certifies that Participant has no medical, psychological or physical condition which could interfere with Participant’s safety in the Events, and Participant is willing to assume and bear the cost of all risks that may be created directly or indirectly by any pre-existing medical, psychological or physical condition. Participant certifies that there are no medical or psychological conditions currently affecting Participant or which Participant has experienced in the past that would, if disclosed, adversely impact Participant’s safety or the safety of others in connection with Participant’s participation in the Events. Participant must provide and keep with Participant at all times all necessary medication required to maintain Participant’s health and safety in the Events.

Medical Treatment. Participant consents to Participant receiving medical treatment, and Participant being transported to a medical facility (all at the sole cost of Participant), in the event that Participant becomes injured or ill during the course of the Events.

General Release and Indemnity. Under no circumstances shall BWJ, LLC have any duty to determine whether it is advisable for Participant to participate in the Events. Participant hereby assumes full responsibility for Participant’s injury, and the injury of any other person caused by Participant, and any property damage caused or suffered by Participant while Participant is observing or participating in any of the Events.

PARTICIPANT HEREBY RELEASE, WAIVE, AND DISCHARGE BWJ, LLC, ITS AFFILIATES, SPONSORS, EMPLOYEES, OWNERS, AND THEIR RESPECTIVE OFFICERS, DIRECTORS, SHAREHOLDERS, PARTNERS, EMPLOYEES, MEMBERS AND AGENTS (WHICH PERSONS ARE HEREINAFTER REFERRED TO AS “RELEASEES”), FROM ANY AND ALL LIABILITY TO PARTICIPANT, PARTICIPANT’S PERSONAL REPRESENTATIVES, ASSIGNS AND HEIRS FOR ANY AND ALL LOSSES AND COSTS, INCLUDING BUT NOT LIMITED TO ATTORNEYS’ FEES AND OTHER EXPENSES OR DAMAGES, WHETHER ACTUAL, INCIDENTAL, CONSEQUENTIAL, OR SPECIAL AND ANY AND ALL CLAIMS OR DEMANDS ON ACCOUNT OF ANY INJURY TO PARTICIPANT, OR DAMAGE TO ANY PROPERTY REGARDLESS OF WHETHER SUCH INJURY, OR DAMAGE IS CAUSED BY ANY ACT OR OMISSION OF RELEASEES, INCLUDING BUT NOT LIMITED TO THE NEGLIGENCE OF RELEASEES, WHILE PARTICIPANT IS USING BWJ, LLC EQUIPMENT AND FACILITIES AND/OR OBSERVING OR PARTICIPATING IN THE EVENTS.

Publicity Release. Participant consents to the free and unrestricted use of Participant’s name, picture, and likeness in any and all promotional materials, video, web sites, telecasts, and promotions for any purposes deemed necessary by BWJ, LLC, its sponsors or licensees, including but not limited to commercial use.

Scope of Agreement. This Agreement specifically applies to all of the Events, functions and activities sponsored, owned or managed by one or more of the Releasees and has the same effect as if executed before each such Event, function or activity in which Participant participates so that Releasees are fully and effectively released and indemnified as to each and every such event, function, and activity.

Law & Court Proceedings. Participant and BWJ, LLC agree that the statutes and laws of the State of Minnesota, without regard to the conflict of laws principles thereof, will apply to all matters relating to this Agreement, or other matters regarding any of the Events. Participant agrees that exclusive jurisdiction for any dispute with Releasees resides in the courts of the State of Minnesota, and Participant further agrees and expressly consents to the exercise of personal jurisdiction in the courts of the State of Minnesota in connection with any dispute including any claim involving Releasees.

Severability. If any provision of this Agreement shall be held by any court of competent jurisdiction to be illegal, invalid or unenforceable, such provision shall be construed and enforced as if it had been more narrowly drawn so as not to be illegal, invalid or unenforceable, and such illegality, invalidity or unenforceability shall have no effect upon and shall not impair the enforceability of any other provision of this Agreement. This Agreement will be binding upon the Participant and their heirs, executors, administrators and other legal representatives and will be for the benefit of Releasees.

PARTICIPANT ACKNOWLEDGES THAT THEY HAVE READ AND UNDERSTAND THIS ENTIRE AGREEMENT AND PARTICIPANT WISHES TO PARTICIPATE IN THE EVENTS BASED UPON THE TERMS OF THIS AGREEMENT. PARTICIPANT ACKNOWLEDGES THAT NO ORAL REPRESENTATIONS, STATEMENTS, OR INDUCEMENTS APART FROM THE FOREGOING AGREEMENT HAVE BEEN MADE.

BY SIGNING THIS DOCUMENT, PARTICIPANT ACKNOWLEDGES THAT IF ANYONE IS HURT AND/OR PROPERTY IS DAMAGED DURING PARTICIPANT’S PARTICIPATION IN THE EVENTS, BY THEIR SIGNATURE ON THIS AGREEMENT, HAVE WAIVED THE LEGAL RIGHTS REQUIRED TO MAINTAIN A LAWSUIT OR OTHER PROCEEDING FOR DAMAGES AGAINST RELEASEES. PARTICIPANT HAS HAD SUFFICIENT OPPORTUNITY TO READ THIS AGREEMENT AND HAVE HAD THE OPPORTUNITY TO CONSULT LEGAL COUNSEL IF DESIRED. PARTICIPANT UNDERSTANDS THIS AGREEMENT AND AGREES TO BE BOUND BY ITS TERMS.
Emergency Contact Details
Particpant's Full Name*
First Last
Participant's Date of Birth*
Contact Phone*
Health Insurance Provider of Participant*
Emergency Contact Name*
First Last
Relationship to Participant*
Emergency Contact Primary Phone*
Emergency Contact Secondary Phone
Signature (Please type name for online registration)*
Today's Date
Payment Method*
- Check
- Cash
- Invoice
- Paypal
- Payment Plan
- College/School Sponsorship
- Business/Organization Sponsorship

Register HEART of a Warrior

Personal Details

Training Questionnaire

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