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Fight Sports Miami Participation Waiver for Martial Arts and Fitness Classes, group and private lessons, classes, seminars and open mats. 

 

 

 

I hereby am choosing to continue my training at Fight Sports Miami.I understand that there are risks associated with my participation and I fully accept and release the owner, Robert De Abreu Filho and The Staff at Fight Sports Miami from any responsibilities related to any likelihood of contracting COVID-19 during today's visit. I fully confirm that I have not tested positive for COVID-19  I do not have any symptoms currently related to COVID-19 (including but not limited to fever, cough, nausea, diarrhea, vomitting, shortness of breath, ect. )  I am also truthfully stating that I have not traveled outsaide the US in the last 4 weeks nor have had any contact with anyone who may have any symptoms concurrent with COVID-19 (including but not limited to fever, cough, nausea, diarrhea, vomitting, shortness of breath, ect.)

I Agree

 

First Students Name

First Name*

Last Name*

Phone*
First Students Date of Birth*
First Students Information
Do you have any flu like symptoms, fever, chills, shortness of breath, cough or body aches?*
No
Yes
Do you have a significant chronic illness?*
No
Yes
Do you have a compromised immune system?*
No
Yes
Have you traveled out of the country in the last two weeks?*
No
Yes
Have you previously been asked to self quarantine?*
No
Yes
Have you had close contact to an individual diagnosed with COVID-19?*
No
Yes
Did you recently test positive for COVID-19?*
No
Yes
First Students Signature*
Second Students Name

First Name*

Last Name*
Second Students Date of Birth*
Second Students Information
Do you have any flu like symptoms, fever, chills, shortness of breath, cough or body aches?*
No
Yes
Do you have a significant chronic illness?*
No
Yes
Do you have a compromised immune system?*
No
Yes
Have you traveled out of the country in the last two weeks?*
No
Yes
Have you previously been asked to self quarantine?*
No
Yes
Have you had close contact to an individual diagnosed with COVID-19?*
No
Yes
Did you recently test positive for COVID-19?*
No
Yes
Third Students Name

First Name*

Last Name*
Third Students Date of Birth*
Third Students Information
Do you have any flu like symptoms, fever, chills, shortness of breath, cough or body aches?*
No
Yes
Do you have a significant chronic illness?*
No
Yes
Do you have a compromised immune system?*
No
Yes
Have you traveled out of the country in the last two weeks?*
No
Yes
Have you previously been asked to self quarantine?*
No
Yes
Have you had close contact to an individual diagnosed with COVID-19?*
No
Yes
Did you recently test positive for COVID-19?*
No
Yes
Fourth Students Name

First Name*

Last Name*
Fourth Students Date of Birth*
Fourth Students Information
Do you have any flu like symptoms, fever, chills, shortness of breath, cough or body aches?*
No
Yes
Do you have a significant chronic illness?*
No
Yes
Do you have a compromised immune system?*
No
Yes
Have you traveled out of the country in the last two weeks?*
No
Yes
Have you previously been asked to self quarantine?*
No
Yes
Have you had close contact to an individual diagnosed with COVID-19?*
No
Yes
Did you recently test positive for COVID-19?*
No
Yes
Fifth Students Name

First Name*

Last Name*
Fifth Students Date of Birth*
Fifth Students Information
Do you have any flu like symptoms, fever, chills, shortness of breath, cough or body aches?*
No
Yes
Do you have a significant chronic illness?*
No
Yes
Do you have a compromised immune system?*
No
Yes
Have you traveled out of the country in the last two weeks?*
No
Yes
Have you previously been asked to self quarantine?*
No
Yes
Have you had close contact to an individual diagnosed with COVID-19?*
No
Yes
Did you recently test positive for COVID-19?*
No
Yes
Sixth Students Name

First Name*

Last Name*
Sixth Students Date of Birth*
Sixth Students Information
Do you have any flu like symptoms, fever, chills, shortness of breath, cough or body aches?*
No
Yes
Do you have a significant chronic illness?*
No
Yes
Do you have a compromised immune system?*
No
Yes
Have you traveled out of the country in the last two weeks?*
No
Yes
Have you previously been asked to self quarantine?*
No
Yes
Have you had close contact to an individual diagnosed with COVID-19?*
No
Yes
Did you recently test positive for COVID-19?*
No
Yes
Seventh Students Name

First Name*

Last Name*
Seventh Students Date of Birth*
Seventh Students Information
Do you have any flu like symptoms, fever, chills, shortness of breath, cough or body aches?*
No
Yes
Do you have a significant chronic illness?*
No
Yes
Do you have a compromised immune system?*
No
Yes
Have you traveled out of the country in the last two weeks?*
No
Yes
Have you previously been asked to self quarantine?*
No
Yes
Have you had close contact to an individual diagnosed with COVID-19?*
No
Yes
Did you recently test positive for COVID-19?*
No
Yes
Eighth Students Name

First Name*

Last Name*
Eighth Students Date of Birth*
Eighth Students Information
Do you have any flu like symptoms, fever, chills, shortness of breath, cough or body aches?*
No
Yes
Do you have a significant chronic illness?*
No
Yes
Do you have a compromised immune system?*
No
Yes
Have you traveled out of the country in the last two weeks?*
No
Yes
Have you previously been asked to self quarantine?*
No
Yes
Have you had close contact to an individual diagnosed with COVID-19?*
No
Yes
Did you recently test positive for COVID-19?*
No
Yes
Ninth Students Name

First Name*

Last Name*
Ninth Students Date of Birth*
Ninth Students Information
Do you have any flu like symptoms, fever, chills, shortness of breath, cough or body aches?*
No
Yes
Do you have a significant chronic illness?*
No
Yes
Do you have a compromised immune system?*
No
Yes
Have you traveled out of the country in the last two weeks?*
No
Yes
Have you previously been asked to self quarantine?*
No
Yes
Have you had close contact to an individual diagnosed with COVID-19?*
No
Yes
Did you recently test positive for COVID-19?*
No
Yes
Tenth Students Name

First Name*

Last Name*
Tenth Students Date of Birth*
Tenth Students Information
Do you have any flu like symptoms, fever, chills, shortness of breath, cough or body aches?*
No
Yes
Do you have a significant chronic illness?*
No
Yes
Do you have a compromised immune system?*
No
Yes
Have you traveled out of the country in the last two weeks?*
No
Yes
Have you previously been asked to self quarantine?*
No
Yes
Have you had close contact to an individual diagnosed with COVID-19?*
No
Yes
Did you recently test positive for COVID-19?*
No
Yes
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Do you have any flu like symptoms, fever, chills, shortness of breath, cough or body aches?*
No
Yes
Do you have a significant chronic illness?*
No
Yes
Do you have a compromised immune system?*
No
Yes
Have you traveled out of the country in the last two weeks?*
No
Yes
Have you previously been asked to self quarantine?*
No
Yes
Have you had close contact to an individual diagnosed with COVID-19?*
No
Yes
Did you recently test positive for COVID-19?*
No
Yes
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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