Legendary Preparatory Academy ("LPA") has contracted with Dysruptive Entities, LLC d/b/a VINNA Human Performance ("VINNA") to provide baseline testing, injury screening, and basic treatment to LPA athletes on a weekly scheduled basis. LPA's contract does not authorize care for your child. Your signature below is what does. Without it, VINNA will not evaluate or treat your child.
Services Provided
VINNA provides physical therapy services under A.R.S. Title 32, Chapter 19, delivered by Arizona-licensed physical therapists during scheduled weekly sessions on LPA premises. Services include baseline and periodic objective performance testing, screening and evaluation of musculoskeletal injuries and complaints, a physical therapy diagnosis within the physical therapy scope of practice, basic treatment including manual therapy, therapeutic exercise, and taping or bracing, recommendations on activity modification, and referral to a physician when appropriate. A physical therapy diagnosis concerns movement and function; it is not a medical diagnosis.
VINNA does not evaluate, diagnose, manage, or clear concussions or head injuries. Arizona law (A.R.S. § 15-341) reserves that to a physician, licensed athletic trainer, nurse practitioner, or physician assistant. If VINNA observes or is told of anything suggesting a head injury, VINNA will stop, will not evaluate it, and will immediately notify LPA.
VINNA is present only during scheduled weekly sessions. VINNA does not attend practices, games, or travel, does not provide sideline coverage or emergency response, and is not available between sessions. If your child is seriously injured when VINNA is not present, do not wait for the next session — seek care from your physician, urgent care, or an emergency department as warranted.
VINNA does not replace your child's physician, does not prescribe or administer medication, does not perform sports physicals, does not provide strength and conditioning or sports performance services, and does not override any instruction from your child's physician or surgeon.
Consent to Examination and Treatment
You authorize VINNA to test, screen, examine, and treat your child at LPA during the 2026–2027 school year. You and your child have the right to ask questions and receive an understandable answer; to receive the findings, physical therapy diagnosis, and prognosis; to refuse any examination or treatment or withdraw consent at any time without penalty; and to select another physical therapy provider at any time.
Health Disclosure
You represent that you are the athlete's parent or legal guardian with authority to consent to health care, and that all health history provided to LPA or VINNA is complete and accurate, including injuries, surgeries and dates, medical conditions, medications, allergies, and any activity restriction imposed by a provider. If your child is under a physician's care or within 24 months of surgery, you have disclosed every restriction and will provide any written protocol on request. You will promptly notify VINNA of any change.
Assumption of Risks
Testing, screening, and treatment involve risks including muscle soreness, strain, and sprain; joint, ligament, tendon, or cartilage injury; fracture; skin irritation from tape or bracing; temporary increase in symptoms; dizziness or fainting; aggravation of an existing injury; re-injury; and, rarely, more serious injury. For a growing athlete, risks also include growth plate and apophyseal injury. Knowing these risks, you voluntarily assume them on your child's behalf and in your own individual capacity.
Release of Liability
You release VINNA Human Performance, Dysruptive Entities, LLC, and their owners, officers, employees, contractors, agents, and representatives ("Released Parties") from claims for ordinary negligence arising from the inherent risks described above and from conditions of premises VINNA does not own or control, to the fullest extent Arizona law permits. VINNA is not responsible for injuries occurring during athletic participation.
This release does not apply to, and you do not waive, claims for: (a) professional negligence, malpractice, or lack of informed consent arising from the practice of physical therapy; (b) gross negligence, recklessness, or willful or intentional misconduct; or (c) any matter for which a release is prohibited by Arizona law or public policy. Nothing here prevents you from filing a complaint with the Arizona State Board of Physical Therapy or any government agency. This form does not release LPA.
Indemnification
You agree to indemnify and hold the Released Parties harmless from third-party claims arising from any material misrepresentation or omission in the health information provided, or from intentional or reckless conduct. This does not apply to claims arising from a Released Party's own negligence or misconduct, and does not apply to any claim brought by or on behalf of your child for injury to your child.
Emergency Care
If an emergency occurs while VINNA is with your child, you authorize VINNA to summon emergency medical services and authorize emergency personnel to evaluate, treat, and transport your child. VINNA and LPA will contact you as soon as practicable. You are responsible for medical expenses incurred. At all other times, emergency response is LPA's responsibility under its own procedures.
Communication and Records
VINNA will notify you of any injury evaluated, any recommended activity restriction, and any recommendation that your child see a physician. VINNA will share with LPA coaches and staff only your child's participation status and any activity restriction they must follow, and will not share diagnosis, medical history, or clinical detail. You authorize VINNA to exchange information with your child's treating physician to coordinate safe participation.
VINNA maintains a confidential physical therapy record for your child under A.R.S. § 12-2291 et seq., available to you on written request under A.R.S. § 12-2293. Records and testing data will not be released to LPA administration, a coach, a college, a recruiter, or any other third party without your separate written authorization. A request from a coach or school official is not authorization.
No Obligation to Use VINNA for Further Care
VINNA also operates a separate private practice on a paid, self-pay basis. If VINNA recommends further evaluation or treatment beyond what is provided at LPA, you are under no obligation to use VINNA. You are free to choose any provider, and your choice will not affect your child's participation, playing time, standing on any team, or the care VINNA provides at LPA. Care at VINNA's private practice requires separate agreements and separate consent. On request, VINNA will provide referral options other than itself.
Use of Images and Video
VINNA may capture photographs and video during testing and treatment for clinical and internal purposes as part of your child's record. Marketing or promotional use requires your consent below.
Minors and Governing Law
You sign both on your child's behalf and individually, as to your own claims and obligations. Arizona law regarding a parent's pre-injury release of a minor's claims is unsettled; this release may not be enforceable as to your child's own claims, and VINNA has not represented otherwise. This consent is effective for the 2026–2027 school year, expires at the end of that year or when VINNA's agreement with LPA ends, and may be withdrawn at any time by written notice to VINNA and LPA. Arizona law governs, venue is Maricopa County, and if any provision is unenforceable it will be reformed or severed with the remainder in effect. Electronic signatures have the same effect as handwritten ones.
Acknowledgment
I have read this Agreement fully and understand its terms. I have had the opportunity to ask questions. I understand that by signing I am giving up substantial rights, including the right to sue for the claims released above. I sign voluntarily.
