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Mantis Boxing and Brazilian Jiu-Jitsu

Waiver and Release of Liability


Review Randy Brown Mantis Boxing and Brazilian Jiu-Jitsu Privacy Policy


TERMS/CONDITIONS
Nor'easter Martial Arts, LLC d.b.a. Randy Brown Mantis Boxing and Brazilian Jiu-Jitsu reserves the right to dismiss any student due to misconduct, failure to obey rules or policies, disruptive behavior, or any other violation of Nor'easter Martial Arts, LLC policy. I agree to join Nor'easter Martial Arts, LLC under all of the terms and conditions set forth on this application.

I understand that classes at Nor'easter Martial Arts, LLC d.b.a. Randy Brown Mantis Boxing and Brazilian Jiu-Jitsu, may be physically strenuous, and I voluntarily participate in them with full knowledge that this involves the risk of all types of personal injury, property loss, or death.

I Agree

I understand that it is my responsibility to consult a physician before beginning my training.

I Agree

IĀ understand that it is my responsibility to provide the proper equipment for my activities at Nor'easter Martial Arts, LLC, and my responsibility to maintain my equipment in safe operating condition.

I Agree

I am responsible for any medical expenses I incur as a result of my training at Nor'easter Martial Arts, LLC.

I Agree

I agree to release Nor'easter Martial Arts, LLC, its officers, agents, and employees from any and all liability arising from any loss, damage, injury or cause of action resulting from my participation in Nor'easter Martial Arts, LLC classes, competitions, or events, or in traveling to or from classes, practices, competitions, events and social activities. This promise extends to liability arising from negligence of Nor'easter Martial Arts, LLC, its officers, agents, and employees, and any other cause. I further agree, for myself, my heirs, executor, or administrator, to indemnify Nor'easter Martial Arts, LLC and its officers, agents and employees and hold them harmless from any such liability, claims, demands or causes of action.

I Agree

If an emergency contact, parent, or guardianĀ cannot be contacted in the event of a medical emergency requiring immediate attention, I hereby consent to allow Nor'easter Martial Arts, LLC to take action to place this applicant into the care of a qualified healthcare professional and/or an appropriate medical treatment authority or facility, and do hereby release Nor'easter Martial Arts, LLC , its principals, instructors, and others associated with Nor'easter Martial Arts, LLC from any and all liability for any consequence arising from such action.

I Agree

First Students Name

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

Email*

Confirm Email*
randy@randybrownmantisboxing.com
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*

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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