Approximate current weight blanks* Goal Weight blank*
I, the undersigned, waive and release any and all rights that I, my heirs, executors, administrators, or assignees for all personal injuries, known or unknown, and injuries to property, real or personal, caused by or arising out of the above described activities. If I observe any unusual, significant rule violations or hazards during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately.I, the undersigned, fully understand and appreciate that participation in sports activities carries a risk to me or serious injury, including permanent paralysis or death. I voluntarily and knowingly recognize, accept, and assume the risk.I, the undersigned, have read this Release/Waiver and understand all its terms and conditions. I execute it voluntarily and with full knowledge of its significance.I, understand in consideration for participation with Jack Costello Boxing Club, I hereby permit and authorize Jack Costello Boxing Club, and its employees, agents and representatives who are acting on behalf of Jack Costello Boxing Club to use my likeness and/or name in any photograph, image, video, motion picture, performance or sound recording for purposes related to its mission including advertising, publicizing or marketing its gym and programs or for any other commercial or lawful purpose, and to use and license others to use it for such purposes, without any compensation to me.
I, understand that the above named participant named in the above application will follow all rules posted within the code of conduct located in the gym. Failure to do so can/will result in immedietate revocation of membship with no refund.
I certify that I am not pregnant or have any painful pelvic discomfort such as systematic endometriosis or other causes, abnormal vaginal bleeding of undetermined causes (etiology), recent loss of menstrual period (secondary amenorrhea), recently developed breast mass, resent breast dysfunction previously not present or surgical breast implants. I further agree that i will immediately notify my coach/club official if any of the above described conditions develop/apply.