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Nati Ninja

 

WAIVER OF LIABILITY – ASSUMPTION OF FULL RESPONSIBILITY FOR ALL RISKS OF BODILY INJURY, DEATH OR DAMAGES – MEDICAL AUTHORIZATION

As a participant, or a parent or legal guardian of the child(ren) listed below, I hereby consent to my/his/her participation in one or more of the programs offered by Nati Ninja. I understand that participation in Facility Rental, Boot Camp, Ninja Obstacle Course and all other activities at Nati Ninja may result in unavoidable injuries including, but not limited to, muscle or other soft tissue strains, sprains and tears, broken bones, .and severe injuries such as paralysis or death from various causes, known and unknown, which include, but are not limited to, the heights of the equipment and body position during certain movements, rotation of the body, and movement of the body, in a unique environment. I acknowledge that I am fully aware of the inherent risks involved in the afore-mentioned activities.

In consideration for using, or allowing my child(ren) to use these facilities, I, on my own behalf and on the behalf of my child(ren) and our respective heirs, administrators, executors and successors, hereby COVENANT NOT TO SUE and FOREVER RELEASE Nati Ninja its officers, directors, shareholders, employees, or agents from all liability for any and all damages or injuries suffered by myself or my child(ren). I further understand that I have been instructed on the general use of the equipment and I will in good faith endeavor to instruct and supervise myself & my children according to these instructions. In the event of an accident or emergency I would like myself or my child(ren) to be taken to a hospital for medical treatment and I hold Nati Ninja and its representatives harmless in their execution of this action. Additionally, I hereby agree to individually provide for all possible future medical expenses which may be incurred by me or my child(ren) as a result of any injury sustained while participating at or for Nati Ninja.

I have read and understand the ASSUMPTION OF RISK and WAIVER OF LIABILITY and MEDICAL AUTHORIZATION and I VOLUNTARILY affix my name in agreement.

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
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*
Parent or Guardian's Email Address

Email*

Confirm Email*
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Emergency Contact

Emergency Contact's 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.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*

Phone*
Parent or Guardian's 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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