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This is our general waiver agreement to participate in class activities with Amalgam Martial Academy.

The enrollee is aware in making this agreement to participate in training in the martial 
arts that certain elements of this training are physically demanding and potentially dangerous, 
and with this knowledge agrees to indemnify and hold harmless from all losses caused by 
accident or injury the Instructors, assistants, or any third parties who may be enrollees of the 
same class or seminar or who are students with the Instructors, in the event that the enrollee or 
the said third party is injured in any way during the proper performance and execution of 
techniques or instruction provided in this training. 

I Agree


This release shall also include any landlord or leaseholder of any training facility in 
which training is conducted. I also agree that the terms hereof shall serve as a release and 
assumption of risk for my heirs, executors and administrators, and for all members of my family, 
including any minors.

I Agree


The enrollee attests that he/she is in good physical condition and has no known or 
suspected medical conditions that would preclude vigorous physical activity.

I Agree

It is recommended that participants have a checkup by a physician before beginning any new 
physical regimen.


It is further agreed that the enrollee's name, photograph or other representation for the 
purposes of promotion or publicity for this martial art program or the instructor may be used.

I Agree


As part of the consideration for participation, the enrollee acknowledges and assumes all 
these risks and wishes to enroll in this course of instruction.


May 18, 2025 

First Participant's Name
First Name*
Middle Name
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant's Signature*
Second Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.
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*
Middle Name
Last Name*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
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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