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DYNAMIX MANAGEMENT, INC 

RELEASE AND WAIVER OF LIABILITY 

TODAY'S DATE: December 4, 2020                   

I, myself, my spouse, legal representatives, heirs and assigns, hereby waive all claims against any and all persons associated with and/or employed by Dynamix A4, Dynamix MMA, and all gym locations affiliated with Dynamix Management, Inc. I warrant that all information in this sheet is true and disclosed completely to its fullest nature. I state that I am in good physical condition and of sound mind and know of no reason why I cannot participate in such vigorous and strenuous activities without any threat to my health and safety.

I understand and fully acknowledge the inherent risks of participating in all Dynamix activities at all locations and fully assume the dangers and risks, whether obvious or latent, associated with such participation, including all events under the auspices of Dynamix Management, Inc. These risks include, but are not limited to: falls which can result in serious injury or death while in the building, or on the premises, including adjacent sidewalks and parking areas; injury or death due to negligence on the part of myself, my training partner, or other people around me, whether the training is supervised or unsupervised; injury or death due to improper use or failure of equipment or facilities regardless of whether such injuries result, in whole or in part, from the negligence of the company; and injury or death resulting from exposure to communicable illnesses transmitted from equipment and/or other students. Injury may also result simply from the fact of physical training itself or the effects of the weather, including high heat and/or humidity. I agree to conduct myself in a controlled and reasonable manner at all times, and to refrain from using any equipment in a manner inconsistent with its intended design and purpose. All exercise is done at my own risk and therefore:

I hereby release Dynamix A4, Dynamix MMA, and all gym locations affiliated with Dynamix Management, Inc. and all of its instructors, agents, employees, successors and associates from any and all liability, claims, demands, actions, medical bills, and causes of action whatsoever arising out of or relating to any negligent or other act or omission, and/or any loss, damage, or injury, including death, that may be sustained.

I understand that if I am participating in martial arts, the training has full body contact. I understand that this includes, but is not limited to, choke holds, joint manipulation, arm/shoulder locks, neck cranks, foot/ankle/knee locks, throws, slams, punches, kicks, elbows, knees, which could potentially cause serious injury or even death. I assume full responsibility for all of my actions during and connected to the above activities.

I understand that in case of emergency, I hereby authorize any licensed medical personnel to perform any accepted medical assistance deemed necessary and I agree to bear the expense of any such treatment.

If I am signing on behalf of a minor child, I also give full permission for any person connected with Dynamix A4, Dynamix MMA, and all gym locations affiliated with Dynamix Management, Inc. to administer first aid deemed necessary, and in case of serious illness or injury, I give permission to call for medical and or surgical care for the child and to transport the child to a medical facility deemed necessary for the well-being of the child and I agree to bear the expense of any such treatment.

If I am signing on behalf of a minor child, I will instruct the minor participant that prior to participating in any Dynamix activities or events, he or she should inspect the facilities and equipment to be used, and if he or she believes anything is unsafe, the participant should immediately advise the coach of such condition and refuse to participate.  I understand and agree that, if at any time, I feel anything to be unsafe; I will immediately take all precautions to avoid the unsafe area and refuse to participate further.    

I agree to be solely responsible for the safety and well-being of my myself and any guests, including my children or any minors that I bring to Dynamix A4, Dynamix MMA, and all gym locations affiliated with Dynamix Management, Inc.

I understand that Dynamix activities may require that two (2) or more individuals, of any gender, work together in close physical contact. I acknowledge that such contact is solely for instructional or training purposes and that such physical contact is in no way any form of sexual harassment.

As additional consideration for training at Dynamix A4, Dynamix MMA, and all gym locations affiliated with Dynamix Management, Inc., I agree that my attendance and/or performance at the academy and abroad at events may be photographed, filmed and/or taped and used by Dynamix Management, Inc. for marketing purposes or media releases. I authorize the use of my image and I waive any compensation thereof even if I discontinue my training at Dynamix A4, Dynamix MMA, and all gym locations affiliated with Dynamix Management, Inc.

I acknowledge that I would like to receive correspondence from Dynamix Management, Inc. via telephone, mail, and email.

I, being duly aware of the risks and hazards inherent upon participating in the forms of training at Dynamix A4, Dynamix MMA, and all gym locations affiliated with Dynamix Management, Inc., agree to all its rules, terms and conditions.

I acknowledge that I have read and understand the Dynamix Management, Inc. rules, and agree to honor and obey them at all times. I understand that disobeying the rules may, at the discretion of instructors or management, result in suspension or expulsion from Dynamix A4, Dynamix MMA, and all gym locations affiliated with Dynamix Management, Inc. and that I will not be entitled to a refund should this occur and that such decisions in all matters are final.

I agree to pay for all legal fees and other costs incurred by Dynamix Management, Inc. as a result of any claims made by me or on my behalf.

In signing the foregoing release, I hereby acknowledge and represent that I have read the foregoing release, understand and sign it voluntarily, and I am over 18 years of age and of sound mind.

If the student is under 18, I certify that this release is being signed by a parent or legal guardian and that I agree to all of its terms and conditions on behalf of the minor student. 

I CERTIFY THAT I HAVE READ AND UNDERSTOOD THE FOREGOING RELEASE AND WAIVER OF LIABILITY AND I CERTIFY THAT I AM SIGNING THIS AGREEMENT, AFTER HAVING CAREFULLY READ IT, OF MY OWN FREE WILL.
                        

                                     

            

        

 

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*
Second Participant's Signature*
Third Participant's Name

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth 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*
Check to receive information, news, and discounts by e-mail.
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*

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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