SSG Registration Form

Member Registration + Waiver Form

(For students under 18 years of age, this form must be filled out by a parent or legal guardian)
Participant Information:
Participant Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Date of Birth

MonthDayYear
Date
Gender

MaleFemaleOther
Emergency Contact Information:
Contact Name*

First NameLast Name
Relationship
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Health Questionnaire:
Do you have any medical conditions, injuries, or allergies that may affect your ability to train?

Yes No If Yes, please specify:
Do you have any medical conditions, injuries, or allergies that may affect your ability to train?

Yes No If Yes, please specify:
Media Release:
I hereby grant Special Strength Gym the irrevocable right and permission to use photographs and/or video recordings of me taken during martial arts classes and related events. These materials may be used for promotional purposes, including but not limited to social media, marketing materials, and the Special Strength Gym website. I understand that I will not be entitled to any compensation for the use of these materials.

I also understand that I have the right to request in writing that any specific image or footage of me not be used for promotional purposes.

I hereby sign this form by inputting my name below.

** If participant is under 18, a parent or guardian must sign the form by entering their name below: **
Participant / Guardian Name*

First NameLast Name
Date

MonthDayYear
Date
Waiver and Release:
I, the undersigned, understand that participating in martial arts classes at Special Strength Gym involves a risk of injury. I hereby assume all risks and responsibilities associated with my participation. I certify that I am physically fit and able to participate in the classes.

In consideration of being allowed to participate in Special Strength Gym martial arts classes, I hereby release, waive, discharge, and covenant not to sue Special Strength Gym, its instructors, employees, or agents from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me while participating in martial arts classes.

I understand and agree that this release includes any claims based on the actions, omissions, or negligence of Special Strength Gym, its instructors, employees, or agents before, during, or after participation in any martial arts class.

I have read this waiver and release and fully understand its terms. I voluntarily sign it with full knowledge of its significance.

I hereby sign this form by inputting my name below.

** If participant is under 18, a parent or guardian must sign the form by entering their name below: **
Participant / Guardian Name*

First NameLast Name
Date

MonthDayYear
Date
Parent/Guardian Consent:

(If participant is under 18)
I, the undersigned parent or legal guardian of the above-named participant, hereby give my consent for them to participate in Special Strength Gym martial arts classes and grant the media release and agree to the waivers as described above. I have read and understand the terms of the waiver and release, and I agree to be bound by its terms on behalf of the participant.
Parent / Guardian Name

First NameLast Name
Date

MonthDayYear
Date
Registration Payment:
Membership Plans*
prevnext( X )
SSG Kids Membership: 2 classes / week
($120.00CAD for 1 months)



SSG Kids Membership: 1 class / week
($85.00CAD for 1 months)



Men's Muay Thai Program
($110.00CAD for 1 months)



SSG Monthly Membership
($120.00CAD for 1 months)
Should be Empty:

Member Registration + Waiver Form

Participant Information:

Emergency Contact Information:

Health Questionnaire:

Media Release:

Waiver and Release:

Parent/Guardian Consent:

Registration Payment: