Fite108 Waiver and Release Form
Client Enrolment and Liability Waiver Agreement
Name
First Name
Last Name
Date Of Birth
-
Day
-
Month
Year
Address
Street Address
Street Address Line 2
Suburb
State
Postcode
Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Why have you chosen to do Muay Thai
Type a question
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Do you have any injuries or take any medication that we should know about?
Type a question
Awareness
Instruction will be limited to that of fitness training and Muay Thai boxing techniques. There are risks involved with participation and they are the sole responsibility of the participant. I have informed myself and understand and accept any associated risks regarding these activities at any time within these facilities, including the risk of personal injury. I am not aware of any medical condition that would preclude me for participating in any activity within these premises. If I have any concerns regarding health issues, I will ensure that the gym and trainers will be made aware of these concerns prior to participation. I have the right to withdraw or refuse participation from any activity at any time as do the gym and its trainers reserve the right to limit or refuse the participation of any student or any activity as they deem warranted.
Release and Waiver
Release and Waiver I consent to the use by Fite108 gym of pictures and videos in full or in part, in any form, with or without other material, throughout the world, without limitation, for, promotional material, internet, television, radio, theatrical medium, or any other medium by any devices now known or hereafter devised and I do hereby Waive any compensation in regard thereof as well as any future rights to the aforementioned. I hereby release and discharge Fite108 gym and its staff of any responsibility and liability for personal injury, including loss of life or loss or damage of personal property, while participating in any activity associated with the gym and its staff, on or off the premises. This Release and Waiver applies to all claims, foreseen or unforeseen, including negligence and breach of duty of care. This agreement is intended to be broad based and inclusive as permitted by law. I hereby acknowledge to have read and fully understand the contents of this agreement and recognize that it is a release of liability. You expressly agree to release and discharge the trainer or instructor from any and all claims or causes of action and you agree to voluntarily give up and waive any right that you may otherwise have to bring a legal action against the trainer or instructor for personal injury or property damage.
Fees and Cancellation
The discussed fees will be debited from your account on a fortnightly or monthly basis for 12 months including a 2 week Christmas shutdown period and cannot be stopped or paused. If your payment is rejected for any reason there will be a $15 failed payment fee in addition to your fees. one month written notice is to be given prior to cancellation.
Participant Signature
Date
-
Day
-
Month
Year
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$20 for a 7 day pass
$20.00 AUD
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