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(412) 335-2419
1000 Gregg Street
Carnegie, PA

*ATTENTION: Please only complete this form if you are PRE-REGISTERED/PREPAID for an introductory session or have been requested to do so.   THERE IS A $25 FEE FOR NO-SHOWS or RESCHEDULING IN LESS THAN 24 HOURS

 

 

WAIVER OF LIABILITY

I, hereby acknowledge that as a participant of Wolfpack Boxing, Inc.'s activities, I will be participating in activities that involve a risk of physical injury, including but not limited to full-contact boxing. I further acknowledge that I know, understand and appreciate the risks of participation.,

I hereby release and hold harmless Wolfpack Boxing, Inc., its officers, directors, shareholders, employees, landlords, related entities, agents, contractors and staff, from any and all liability, claims, damages, demands, and other charges by reason of accident, damage to personal property, injury (including death), illness and any other losses arising out of or related to, directly or indirectly, participation in Wolfpack Boxing Inc.'s activities. I confirm that I maintain and am covered by a Medical Insurance Policy, and agree to maintain said Policy or an equivalent Policy throughout the duration of my participation in Wolfpack Boxing Inc.'s activities.

I give my permission to be taken to any hospital or other medical care facility for any emergency or perceived emergency, arising from or related to my participation in Wolfpack Boxing, Inc.'s activities, or occurring on Wolfpack Boxing Inc.'s premises, and to be treated by the medical personnel on call or duty. I specifically release Wolfpack Boxing, Inc., its officers, directors, shareholders, employees, landlords, related entities, agents, contractors and staff from any and all liability, claims, damages, demands, and other charges arising from or related to treatment and transportation for treatment related to said emergency or perceived emergency. Further, I agree to indemnify and defend Wolfpack Boxing, Inc., its officers, directors, shareholders, employees, landlords, related entities, agents, contractors and staff from and against any and all claims, damages, suits, or costs of any nature (including reasonable attorneys' fees) assessed or asserted against the same by any insurer, including but not limited to my own insurer, that in any way relate to my participation in activities at Wolfpack Boxing, Inc.

Wolfpack Boxing Inc. does not hold, transfer or refund introductory session fees. I understand that Wolfpack Boxing Inc. charges a $25 no-show fee in the event that I/We do not give at least 24 hours notice to cancel/reschedule my/our introductory session.  I/We agree to pay this fee prior to attending my/our introductory session(s).

The foregoing has been read and its meaning explained to the above named participant, and I agree to the terms and conditions as stated.

1. Do not sign this waiver before you read it or if any space is intended for the agreed terms is blank.
2. You are entitled to a copy of this waiver at the time you sign it (upon request).

TODAY'S DATE: December 12, 2018

Please select who will be participating...
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First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
Referred by:*
First Participant's Signature*
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
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
I/we, the parent(s)/guardian(s) of the above named participant, give my/our consent to his/her participation in Wolfpack Boxing, Inc.'s activities, with acknowledgment and assumption of any and all risks attendant thereto. I/we have read and fully understand this Waiver of Liability, hereby join in this Waiver of Liability in full, and hereby agree to the releases, terms, conditions, confirmations, permissions and consents herein on behalf of myself and my minor child, and hereby agree that the same will be deemed to have been made by me/us. I/we hereby release and hold harmless Wolfpack Boxing, Inc., its officers, directors, shareholders, employees, landlords, related entities, agents, contractors and staff, from any and all liability, claims, damages, demands, and other charges by reason of accident, damage to personal property, injury (including death), illness and any other losses arising out of or related to, directly or indirectly, the above-named participant's participation in Wolfpack Boxing Inc.'s activities. I/we confirm that I/we maintain a Medical Insurance Policy for the above-named participant, and agree to maintain said Policy or an equivalent Policy throughout the duration of his/her participation in Wolfpack Boxing, Inc.'s activities. I/we give my/our permission for the above-named participant to be taken to any hospital or other medical care facility for any emergency or perceived emergency arising from or related to the above-named participant's participation in Wolfpack Boxing, Inc.'s activities, or occurring on Wolfpack Boxing, Inc.'s premises, and to be treated by the medical personnel on call or duty. I/we specifically release Wolfpack Boxing Inc., its officers, directors, shareholders, employees, landlords, related entities, agents, contractors and staff from any and all liability, claims, damages, demands, and other charges arising from or related to treatment and transportation for treatment related to said emergency or perceived emergency. Further, I/we agree to indemnify and defend Wolfpack Boxing, Inc., its officers, directors, shareholders, employees, landlords, related entities, agents, contractors and staff from and against any and all claims, damages, suits, or costs of any nature (including reasonable attorneys' fees) assessed or asserted against the same by any insurer, including but not limited to my own insurer, that in any way relate to my participation in activities at Wolfpack Boxing, Inc.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Referred by:*
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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