EmailMe Form - Waiver

Your Name (Adult Not Minor Children)

First Middle Last

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Email

Phone

### - ### - ####

Who is participating in the Class? if other than self fill out the below additional participantes

Just Myself

Myself and Child(ren)

Just My Child(ren)

1st participant name other than self (minor child)

First Last

2nd participant name other than self (minor child)

First Last

3rd participant name other than self (minor child)

First Last

Multiple Select *

Do you or other participants have any physical limitations that could be aggravated by martial arts training and or exercise?

Checkbox *

It is your responsibility to inform the instructor of your limitations before class begins.

Checkbox *

I represent and warrant that I am in good physical health and do not suffer from any medical condition which would limit my participation in the classes offered at GAMMA.

Checkbox *

I understand that it is my responsibility to consult with a physician prior to and regarding my participation in any of the martial arts classes, programs, or workshops.

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I understand the risks associated with the activities offered by GAMMA and I agree to follow all instructions so that I may safely participate in classes, workshops, or other activities.

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I hereby WAIVE AND RELEASE Extreme Gym LLC, its owners, officers, employees, and instructors from any claim, demand, cause of action of any kind resulting from or related to my participation in the programs offered at the facility.

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In taking part in the martial arts classes at GAMMA, I understand and acknowledge that I am fully responsible for any and all risks, injuries, or damages, known or unknown, which might occur as a result of my participation in the classes.

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I have read the above release and waiver of liability and fully understand its content. I am legally competent to sign and voluntarily agree to the terms and conditions stated above.

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Please practice mindfully and enjoy the many benefits of training in martial arts with GAMMA.

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By signing this waiver, I agree to the above terms and conditions.

type your name as your signature *

Date Time

MM / DD / YYYY