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Welcome to Westchester Mixed Martial Arts and Fitness!

Please complete the online waiver and permission form to participate in our classes and special events.

Westchester Mixed Martial Arts Inc. PARTICIPANT AGREEMENT, INDEMNIFICATION, WAIVER AND GENERAL RELEASE OF LIABILITY, AND ASSUMPTION OF RISK
 
In acknowledgement of the below terms and in order to allow yourself, your child/children or both to participate in an event or class at Westchester Mixed Martial Arts and Fitness, please fully complete the adjacent form and certify that you understand and agree to the terms of this waiver.  This form is for participation at a specified event or class. It must be filled out in entirety by participants over the age of 18 or by the parent/guardian of participants under the age of 18.
 
By completing and submitting this form, you certify and attest to the following:

In consideration for attendance and participation in the training offered by Westchester Mixed Martial Arts and Fitness (WMMAF), I, the student/parent, acknowledge the existence of certain inherent risks in this type of training and hereby agree to assume all risks.  I further relieve the school, its management, assigned staff and fellow students from any liability resulting from loss, whether personal belonging or bodily injury.  I also hereby state, that myself or my child is physically fit to take the prescribed course of instruction and do so of my own free will in exchange for an agreed upon fee.  I understand there is no refund policy on any monies I may pay WMMAF.  The above also applies to any trials, workshops or complimentary lessons I may take at WMMAF

First Participant Name

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

Last Name*
Tenth Participant Date of Birth*
Participant 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*
Tell Us About You!

What class or event will you be joining us for? *

How did you hear about us?
What would you most like to get from your experience with us?
Confidence
Fitness
Self Defense
Self Discipline
Fun

Are there any medical concerns that 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*

Middle 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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