Course Registration Form

Jai Suu Muay Thai Disclaimer

Fill out the form carefully for registration
I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing. I further acknowledge that Jai Suu Muay Thai has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19. I further acknowledge that Jai Suu Muay Thai cannot guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, coaching staff and other members of the gym and their families. I voluntarily seek services provided by Jai Suu Muay Thai and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment. I attest that: *I am not experiencing any symptom of illness such as cough, shortness of breath ordifficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sorethroat, or new loss of taste or smell.*I have not travelled internationally within the last 14 days.*I have not travelled to a highly impacted area in the last 14 days.*I do not believe I have been exposed to someone with a suspected and/or confirmed caseof the Coronavirus/COVID-19.*I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non-contagious by state or local public health authorities.*I am following all CDC recommended guidelines as much as possible and limiting myexposure to the Coronavirus/COVID-19.I hereby release and agree to hold Jai Suu Muay Thai harmless from, and waive on behalf ofmyself, my heirs, and any personal representatives any and all causes of action, claims,demands, damages, costs, expenses and compensation for damage or loss to myself and/orproperty that may be caused by any act, or failure to act of the gym, or that may otherwisearise in any way in connection with any services received from Jai Suu Muay Thai. Iunderstand that this release discharges Jai Suu Muay Thai from any liability or claim that I,my heirs, or any personal representatives may have against the gym with respect to anybodily injury, illness, death, medical treatment, or property damage that may arise from, orin connection to, any services received from Jai Suu Muay Thai. This liability waiver andrelease extends to the gym together with all owners, partners, and employees.
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COVID Signature
Agreement, Release and Waiver of Liability

Please read carefully and sign
To my best knowledge I am in good physical condition and have no disease, physical
limitation, health concern or injury that would be aggravated, or would be the cause of any
injury sustained, before, during or as a result of my participating in activities related either
directly and/ or indirectly to Jai Suu Muay Thai. I hereby acknowledge that use of the gym
facilities and equipment, participation in the classes, and in the training provided at Jai Suu
Muay Thai exposes me to inherent risks which can include accidents, falls, illness, injury or
even death.
I recognise that exercise might be difficult and strenuous and there could be dangers
inherent in exercise for some individuals. I acknowledge my responsibility in
communicating to a staff member prior to commencing activity, any physical and/or mental
concerns affecting me which could conflict with participation in my chosen gym activities. I
understand that as a result of my participation in an exercise or other program, I could
suffer an injury.
I recognise that an examination by a physician should be obtained by all participants prior
to involvement in any exercise or physical program. If I have chosen not to obtain a
physician’s permission prior to beginning this exercise or physical program with Jai Suu
Muay Thai, I hereby agree that I am doing so at my own risk.
In any event, I acknowledge and agree that I assume the risks associated with any and all
activities and/or exercises in which I participate. I also assume liability for all other such
risks being known and appreciated by me.
I acknowledge that I have thoroughly read this waiver and fully understand the contents of
the agreement. By signing this document, I agree, for myself and anyone entitled to act on
my behalf, to waive and release Jai Suu Muay Thai and successors from liability,
responsibilities, demands and claims arising out of my participation in the training,
programs or events organised by Jai Suu Muay Thai.
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Medical Disclaimer Signature
Students Name*

First NameLast Name
Birth Date*

MonthDayYear
Gender*
Mobile Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student E-mail*
example@example.com
Emergency Contact Person*

First NameLast Name
Emergecny Contact number *
Please enter a valid phone number.
Medical Conditions

Heart condition?Low/High blood pressure?Pre/Post nantal?Joint/bone issues?Hiv/Aids?Dizziness during/after physical activity?Chest pains?Diabetic?Medication?Currently injuredMental health issues?Asthma?
Do you know of any other reason you should not exercise or do physical activity? Y
If you have answered ‘yes’ to any of the above, please give details -
If you have answered yes to any of the above, please speak with a doctor BEFORE you begin training. Please inform your doctor of your intention to exercise and review the questions you answer positively with them.
If at any stage your health changes (resulting in a “yes” answer to any of the questions above) please inform us and seek guidance from your GP.
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Jai Suu Muay Thai Disclaimer

Agreement, Release and Waiver of Liability