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AXÉ MARTIAL ARTS AND FITNESS

NEW STUDENT REGISTRATION FORM

PLEASE READ CAREFULLY!

All sections must be filled out entirely in order to participate.

PART 1: ASSUMPTION OF RISKS:

I (the “participant”), understand that by participating in the classes, programs, workshops, or open-gym sessions (the “activities”) offered by Axé Martial Arts and Fitness, I will receive information and instruction about physical fitness programming, and I recognize that acting on this information or instruction will require the use of the equipment and facilities of Axé Martial Arts and Fitness. I understand that these activities may involve strenuous physical activity including, but not limited to, cardiovascular conditioning, interval training, endurance training, acrobatics, and other various fitness activities. I further understand and am aware of the risks, dangers, and hazards associated with or arising from the use of the equipment and facilities of Axé Martial Arts and Fitness and from participation in the activities, including but not limited to: fainting, heat prostration, abnormal blood pressure, musculoskeletal injuries (such as neck and back strains, muscle strains, muscle pulls, muscle tears, tendon and ligament damage, damage to joints or bone fractures), paralysis, death, or damage to myself, property, or to third parties, resulting from:

  • Falling and impacting wall surfaces or the ground, including any fixed or mobile objects, obstacles, or equipment, including both wooden and metal objects, obstacles, or equipment;
  • Falling participants or equipment, such as shoes, or weights;
  • Participation in the physical activity of the sport itself;
  • Negligence on my part; and/ or negligence on the part of other participants; and/ or negligence on the part of Axé Martial Arts and Fitness or its employees, agents, instructors or independent contractors (collectively the 'Releasees"), including the failure on the part of the Releasees to safeguard or protect me from the risks, dangers and hazards of the activities.

 

I further understand that Axé Martial Arts and Fitness has rules and policies in place regarding safety, the activities, and the use of Axé Martial Arts and Fitness’ equipment and facilities (the "rules"), and I acknowledge that I have reviewed the rules and that I understand the rules. I acknowledge that failure to follow any of the rules may result in complete revocation of all privileges provided by Axé Martial Arts and Fitness without refund of any fees. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the activities offered by Axé Martial Arts and Fitness. I represent and warrant that I am physically fit and I have no medical condition that would prevent my full participation in the exercise classes, programs or workshops. I further represent and warrant that I will not be under the influence of alcohol or any substance, which would impair my ability to undertake activities at Axé Martial Arts and Fitness. I further understand that Axé Martial Arts and Fitness does not carry accident, medical, or dental insurance on my behalf.

I have read above and I voluntarily accept these physical risks.

INITIALS OF PARTICIPANT (OR PARENT / LEGAL GUARDIAN OF PARTICIPANT)

ART 2: RELEASE OF LIABILITY, WAIVER OF CLAIMS & INDEMNIFICATION:

In consideration for Axé Martial Arts and Fitness allowing me to participate in the activities and permitting my use of Axé Martial Arts and Fitness equipment and facilities, and for good and valuable consideration, the receipt and sufficiency of which is acknowledged, I agree as follows:

  • To waive any and all claims that I have or may in the future have against the Releasees and to release the Releasees from any and all liability for any loss, damage, expense or injury including death that I may suffer, or that my next of kin may suffer resulting from my participation in the activities due to any cause whatsoever, including negligence, breach of contract, or breach of any statutory or other duty of care, including any duty of care owed under the Occupiers' Liability Act, R.S.O. 1990, c. O.2, on the part of the Releasees, and also including the failure on the part of the Releasees to safeguard or protect me from the risks, dangers and hazards of the activities referred to above;
  • To hold harmless and indemnify the Releasees from any and all liability for any damage to property of or personal injury to any third party, resulting from my participation in the activities;
  • This agreement shall be effective and binding upon my heirs, next of kin, executors, administrators, and representatives, in the event of my death or incapacity;
  • This agreement limits the liability of the employees, agents, instructors or independent contractors of Axé Martial Arts and Fitness (the "Agents") to the same extent as it limits the liability of Axé Martial Arts and Fitness, even though the Agents are not formally parties to the Agreement;
  • In entering into this agreement I am not relying upon any oral or written representations or statements made by the Releasees with respect to the safety of the activities other than what is set forth in this agreement;
  • This agreement supersedes any prior agreement or understanding between the parties.
  • This agreement and any rights, duties and obligations as between the parties to this agreement shall be governed by and interpreted solely in accordance with the laws of the province of Ontario and no other jurisdiction; and
  • Any litigation involving the parties to this agreement shall be brought solely within the province of Ontario and shall be within the exclusive jurisdiction of the courts of the province of Ontario.

I have read and understand this agreement and I am aware that by signing this agreement I am waiving certain legal rights which I or my heirs, next of kin, executors, administrators and representatives may have against the Releasees.

INITIALS OF PARTICIPANT (OR PARENT / LEGAL GUARDIAN OF PARTICIPANT) 

PART 3: MEDIA PERMISSION CLEARANCE:

I hereby grant permission to Axé Martial Arts and Fitness and its representatives to photograph and video me, and otherwise capture my image, and to make recordings of my voice. I further grant to Axé Martial Arts and Fitness and its representatives the right to reproduce, use, exhibit, display, broadcast and distribute and create derivative works of these images and recordings in any media now known or later developed as well as my name for promoting, publicizing or explaining Axé Martial Arts and Fitness and its activities and for administrative, educational or research purposes.

I have read and acknowledge that Axé Martial Arts and Fitness owns all rights to the images and recordings as described above.

I have read and acknowledge the participant’s image may be captured while taking part in activities at Axé Martial Arts and Fitness.

INITIALS OF PARTICIPANT (OR PARENT / LEGAL GUARDIAN OF PARTICIPANT)

Date: December 13, 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

HEALTH INFORMATION

Do you have any allergies?*

If yes, please list:

HOW DID YOU HEAR ABOUT US?


If Other, Referral or Deal Voucher, please list:
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*

Confirm Email*
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*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

HEALTH INFORMATION

Do you have any allergies?*

If yes, please list:

HOW DID YOU HEAR ABOUT US?


If Other, Referral or Deal Voucher, please list:
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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