Waiver and Release of Liability
Participation in martial arts and fitness training involves inherent risks, including risk of personal injury or death. A physical exam by a qualified physician is recommended prior to commencing any exercise program. The student (or guardian) acknowledges and assumes ALL responsibility for the inherent risks of training and agrees that, Theta Combat Martial Arts, LLC. And Mountainville Academy, Shall not be liable for any claims, injuries, or damages resulting from injury to person or property arising out of or in connection with the student's use of the services, facilities, and premises of the School. Student agrees to abide by School rules and hereby holds the School, its officers, owners, agents and employees harmless from all claims which may be brought against them by student or on student's behalf for any such injuries or claims.
Name
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First Name
Last Name
Phone Number
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Email
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example@example.com
Guardian Name (if under 18 years old)
First Name
Last Name
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
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Please enter a valid phone number.
Date
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-
Month
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Day
Year
Date
Signature
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