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Firestorm Freerunning - Galaxy LLC

Liability Waiver and Assumption of Risk Form
14419 Veterans Way Moreno Valley, Ca 92553

In consideration of being permitted by Firestorm Freerunning - Galaxy LLC ("FFG" herein) to participate in its activities and to use its equipment and facilities, I hereby agree to release, indemnify, and discharge FFG, its agents, owners, managers, employees, volunteers, participants, lessors, affiliates, its subsidiaries, related and affiliated entities, successors and assigns (the "RELEASED PARTIES") on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representatives, and estate as follows:

1) I acknowledge that my participation in programs, classes, and events offered by FFG (the "ACTIVITIES" herein), and my use of the facilities and all related equipment and/or property (The "PREMISES" herein), all entail known and unknown risks of injury, including, but not limited to: physical or emotional injury, death, damage to myself, to property or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activities, and such risks are inherent in using the PREMISES. In any event, if I or my child is injured, I or my child may require medical assistance, at my own expense.

2) I expressly agree and promise to accept and assume all of the risks existing in the ACTIVITIES and in the use of the PREMISES. My participation in the ACTIVITIES is purely voluntary and I elect to participate despite the risks.

3) I acknowledge that while participating in the ACTIVITIES, I will receive information and instruction about various physical fitness activities, including but not limited to, martial arts, parkour and freerunning, tricking, tumbling, dance, and strength/endurance training. I recognize that fitness programs require physical exertion that may be considered strenuous and cause physical injury, and I am fully aware of the risks and hazards involved.

4) I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the ACTIVITIES. I affirm and warrant that I am physically fit and I have no medical condition that would prevent my full participation in the ACTIVITIES. Furthermore, I affirm and warrant that I will not be under the influence of alcohol or any substance that would impair my ability to participate in the ACTIVITIES.

5) In addition, FFG employees strive for safety, but they are not infallible. They may be unaware of a participant's physical and/or mental fitness or abilities. They may give incomplete warnings or instructions, and the equipment used may become loose, out of adjustment, or malfunction. There is also the risk that FFG employees may be negligent in, among other things, monitoring and supervising use of its equipment and facilities and in the maintenance of its equipment and facilities.

6) I, my spouse, assignees, heirs, guardians, and legal representatives hereby voluntarily release, forever discharge, and agree to defend, indemnify and hold harmless the RELEASED PARTIES from any and all claims, demands, or causes of action that are in any way connected with my participation in the ACTIVITIES or my use of the PREMISES, including any such claims arising out of the alleged negligent acts or omissions of the RELEASED PARTIES.

7) I agree that if any action in law or equity is brought to enforce or to interpret the terms of this Release of Liability, the prevailing party shall be entitled to reasonable attorneys' fees and costs in addition to any other relief to which that party might be entitled.

8) I certify that I have adequate insurance to cover any injury or damage that I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage to myself. I further certify that I am willing to assume the risk of any medical or physical condition that I may have.

9) In the event that I file a lawsuit against FFG, I agree to do so solely in the state of California and I further agree that the substantive law of California shall apply in that action without regard to the conflict of the law rules of that state. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect.

10) As an adult participant, and/or as the Parent/Legal Guardian of a minor participant, and in consideration of being permitted to participate at FFG, I hereby grant FFG and any related or affiliated entities, officers, managers, directors, partners, employees, agents, successors and assigns, the irrevocable right and permission to photograph and/or record me or my child(ren)/ward(s) in connection with FFG, and to use the photograph and/or recording for all purposes, including advertising and promotion purposes, in any manner in any and all media now and hereafter known, in perpetuity throughout the world, without restriction as to alteration. I waive any right to inspect or approve the use of any photograph and/or recording, and acknowledge and agree that the rights granted by this release are without compensation of any kind. All photographs and/or recordings are exclusive to FFG.

11) I hereby acknowledge that FFG has rules and policies in place regarding safety and use of the PREMISES. I acknowledge that I have reviewed and understand all safety rules and other rules of participation in the ACTIVITIES, and that failure to comply with or follow any of these rules and policies may result in complete revocation of all privileges provided by FFG without any refund of any prepaid fees.

12) I accept all liability for any damage or destruction of the PREMISES due to my own negligence or failure to comply with FFG's rules and policies, or that of my child(ren)

13) If the participant is a minor, I agree that this Release of Liability and Assumption of Risk agreement is made on behalf of that minor participant and that all of the releases, waivers and promises herein are binding on and applicable to that minor participant. I represent that I have full authority as Parent or Legal Guardian to bind the minor participant to this agreement.

14) If that participant is a minor, I further agree to defend, indemnify, and hold harmless the RELEASED PARTIES from any and all claims or suits for personal injury, property damage, or otherwise that may be brought by or on behalf of the minor and arise out of such use or participation by the minor, including injuries or damage caused by the negligence of RELEASED PARTIES, except those injuries or damages proximately caused by the gross negligence or willful misconduct of the RELEASED PARTIES.

By signing this document, I acknowledge that if anyone is hurt or damaged during my participation in the programs, classes, events or activities at the facilities, I may be found by a court of law to have waived my right to have waived, my, or the minor's participant's right to maintain a lawsuit against FFG or any of the RELEASED PARTIES on the basis of my claim from which I released them herein. I have had sufficient opportunity to read this entire document. By signing this document, I certify that I am 18 years of age or older. I have read and understood it, and I agree to be bound by its terms.

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*
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*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
I Have/Will:
I have/will disclose any of my or my child's Allergies, Previous Injuries, and Learning Disabilities to the Front Office and/or Instructor before participating *
Yes
No
I have/will consult with my or my child's Doctor/Physician about resuming physical activity after an injury/medical procedure. *
Yes
No
I Understand:
I have/will disclose any of my or my child's Allergies, Previous Injuries, and Learning Disabilities to the Front Office and/or Instructor before participating *
Yes
No
I understand that Firestorm Freerunning - Galaxy LLC has the right to refuse service. *
Yes
No
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*

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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