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405 Sullivan Ave

South Windsor Ct 06074

860-436-3500

Today's Date: December 10, 2022

Dual Release of Liability Waiver

I, despite all reasonable precautions implemented for safety, am fully aware of and appreciate the risks, including the risk of catastrophic injury, paralysis and even death, as well as other damages and losses associated with participation in the programs or activities. I knowingly and willingly assume all such risks. Consequently, I hereby for myself, heirs, executors and administrators, do waive and release any and all rights and claims for damages against the owners, operators, coaches and other members of The Three Ninjas, LLC and USA Ninja Challenge from personal injury or accident of any sort or nature suffered by me, the undersigned, by reason of participation or membership in classes, lessons or any programs or activities of USA Ninja Challenge.

I further acknowledge, understand, appreciate, and agree that my and/or my child's participation may result in possible exposure to and illness from infectious diseases, including, but not limited to, MRSA, Influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releasees or others and assume full responsibility for my participation and exposure.

 

Waivers for both Adult and Minor(s) must be filled out prior to Minor(s)' participation
AdultAdult and Minor(s)
1 Minor2 Minors3 Minors4 Minors5 MinorsMore Minors6 Minors7 Minors8 Minors9 Minors10 Minors
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First Ninja's Name

First Name*

Last Name*

Phone*
First Ninja's Date of Birth*
I certify that I am 18 years of age or older
First Ninja's Information
Are there any physical, mental or behavior issues we need to be aware of? (Ninja's only)*
No
Yes

If yes, please explain:
First Ninja's Signature*
Second Ninja's Name

First Name*

Last Name*

Phone*
Second Ninja's Date of Birth*
Second Ninja's Information
Are there any physical, mental or behavior issues we need to be aware of? (Ninja's only)*
No
Yes

If yes, please explain:
Third Ninja's Name

First Name*

Last Name*

Phone*
Third Ninja's Date of Birth*
Third Ninja's Information
Are there any physical, mental or behavior issues we need to be aware of? (Ninja's only)*
No
Yes

If yes, please explain:
Fourth Ninja's Name

First Name*

Last Name*

Phone*
Fourth Ninja's Date of Birth*
Fourth Ninja's Information
Are there any physical, mental or behavior issues we need to be aware of? (Ninja's only)*
No
Yes

If yes, please explain:
Fifth Ninja's Name

First Name*

Last Name*

Phone*
Fifth Ninja's Date of Birth*
Fifth Ninja's Information
Are there any physical, mental or behavior issues we need to be aware of? (Ninja's only)*
No
Yes

If yes, please explain:
Sixth Ninja's Name

First Name*

Last Name*

Phone*
Sixth Ninja's Date of Birth*
Sixth Ninja's Information
Are there any physical, mental or behavior issues we need to be aware of? (Ninja's only)*
No
Yes

If yes, please explain:
Seventh Ninja's Name

First Name*

Last Name*

Phone*
Seventh Ninja's Date of Birth*
Seventh Ninja's Information
Are there any physical, mental or behavior issues we need to be aware of? (Ninja's only)*
No
Yes

If yes, please explain:
Eighth Ninja's Name

First Name*

Last Name*

Phone*
Eighth Ninja's Date of Birth*
Eighth Ninja's Information
Are there any physical, mental or behavior issues we need to be aware of? (Ninja's only)*
No
Yes

If yes, please explain:
Ninth Ninja's Name

First Name*

Last Name*

Phone*
Ninth Ninja's Date of Birth*
Ninth Ninja's Information
Are there any physical, mental or behavior issues we need to be aware of? (Ninja's only)*
No
Yes

If yes, please explain:
Tenth Ninja's Name

First Name*

Last Name*

Phone*
Tenth Ninja's Date of Birth*
Tenth Ninja's Information
Are there any physical, mental or behavior issues we need to be aware of? (Ninja's only)*
No
Yes

If yes, please explain:
Ninja'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.
Are you coming to USA Ninja Challenge for a Birthday Party?
Are you attending a Birthday Party?*
No
Yes

What is the name of the Birthday Ninja?
Emergency Contact

Emergency Contact's Name (Must be different than adult filling out the waiver) *

Emergency Contact's Phone Number *

Relationship *
Permission To Use Photo
Subject:Ninja competitions, workouts, team activities and functions at any USA Ninja Challenge facility or the location of any USANC sanctioned meet or activity. I grant to USA Ninja Challenge, its representatives and employees the right to take photographs of my child in connection with the above identified subject. I authorize USA Ninja Challenge, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that USA Ninja Challenge may use such photographs of my child with or without his/her name for any lawful purpose, including publicity, illustration, advertising, and Web content. I have read and understand the above:*
Yes
No
Minor Release: I, the minor's parent and/or legal guardian, understand the nature of these activities and the minor's experience and capabilities and believe the minor to be qualified, in good health, and in proper physical condition to participate in such activity. I hereby release, discharge, covenant not to sue, and agree to indemnify and save and hold harmless each of the releasee's from all liability claims, demands, losses, or damages on the minor's account, including negligent rescue operations. I further agree that if, despite this release, I, the minor, or anyone on the minor's behalf makes a claim against any of the releasees named above, I will indemnify, save, and hold harmless each of the releasees from any litigation expenses, attorney fees, loss liability, damage, or cost any may incur as the result of any such claim.


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*
I certify that I am 18 years of age or older
Parent or Guardian's Information
Are there any physical, mental or behavior issues we need to be aware of? (Ninja's only)*
No
Yes

If yes, please explain:
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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