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Renton Martial Arts Center

Free Trial Class / Waiver Form

 

I hereby understand and acknowledge that the training, programs and events held by Anaya Enterprises, LLC may expose me to many inherent risks, including accidents, injury, illness, or even death. I assume all risk of injuries associated with participation including but not limited to falls, contact with other participants, the effects of the weather, including high heat and or humidity and all other such risks being known and appreciated by me. I hereby acknowledge by responsibility in communicating any physical and psychological concerns that might conflict with participation in activity. I acknowledge that I am physically fit and mentally capable of performing the physical activity I choose to participate in. It is understood that before participating in any fitness activity, my doctor must first be consulted for personal risks/benefits. After having read this waiver and knowing these facts, and in consideration of acceptance of my participation and Anaya Enterprises, LLC, furnishing services to me, I agree, for myself and anyone entitled to act on my behalf, to HOLD HARMLESS, WAIVE AND RELEASE Anaya Enterprises, LLC, and their officers, agents, employees, organizers, representatives, and successors from any responsibility, liabilities, demands or claims of any kind arising out of my participation in the training, programs and or events. I do hereby give Anaya Enterprises, LLC, and their assigns, licensees, and legal representatives the irrevocable right to use my name, video, picture, portrait or photograph in all forms and media in all manners, including composite, for advertising, for publication or any other lawful purposes, and I waive any right to inspect or approve the finished product, including written copy, which may be created in connection therewith. By my signature, I indicate that I have read and understand this Waiver of Liability and Photo Release. I am aware that this is a waiver and a release of liability and I voluntarily agree to its terms.

Dated: June 25, 2019

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Additional Information
What classes are you interested in? *
Adult Brazilian Jiu Jitsu
Youth Brazilian Jiu Jitsu (7-12 yrs old)
Peewee Brazilian Jiu Jitsu (4-6 yr old)
Taekwondo
Adult/teen Muay Thai
Youth Muay Thai
Fitness Bootcamp
Other / I Don't Know
**I am signing this waiver for participation in a special event

What are you looking to get out of your martial arts training?

How did you hear about us?

Do you (or the participant) have any injuries or allergies we should be aware of?
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*

Last Name*

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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