Amalgam Martial Academy Waiver

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.

Type Initials

Draw Initials

Initial

April 28, 2024

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*

First Participant's Date of Birth*

First Participant's Signature*

Type Signature

Draw Signature

Click to Sign

Second Participant's Name

First Name*

Middle Name

Last Name*

Second Participant's Date of Birth*

Third Participant's Name

First Name*

Middle Name

Last Name*

Third Participant's Date of Birth*

Fourth Participant's Name

First Name*

Middle Name

Last Name*

Fourth Participant's Date of Birth*

Fifth Participant's Name

First Name*

Middle Name

Last Name*

Fifth Participant's Date of Birth*

Sixth Participant's Name

First Name*

Middle Name

Last Name*

Sixth Participant's Date of Birth*

Seventh Participant's Name

First Name*

Middle Name

Last Name*

Seventh Participant's Date of Birth*

Eighth Participant's Name

First Name*

Middle Name

Last Name*

Eighth Participant's Date of Birth*

Ninth Participant's Name

First Name*

Middle Name

Last Name*

Ninth Participant's Date of Birth*

Tenth Participant's Name

First Name*

Middle Name

Last Name*

Tenth Participant's 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*

Parent or Guardian's Signature*

Type Signature

Draw Signature

Click to Sign

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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Agree To This Document