Loading...

Please read and sign the attached waiver BEFORE your first class back at Kickboxing Keene, which includes an addendum for COVID-19.  

WAIVER OF LIABILITY

For and in consideration of being permitted to participate in activities sponsored by Releasee at 233 Marlboro Street, Keene, New Hampshire, and other good and valuable consideration the receipt and sufficiency of which is acknowledged, I RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE Kickboxing Keene, LLC, and its directors, officers, employees, volunteers, representatives, and agents (referred to collectively as “Releasee”) from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me, or to any property belonging to me, whether caused by the negligence of Releasee, or otherwise, while participating in such activities, or while in, on, or upon the premises where the activities are being conducted.  These activities include, but are not limited, to physical exercise, cardiovascular and strength training.  

     I can fully participate in these activities, and I am fully aware of the risks and hazards connected with the activity.  I hereby elect to voluntarily participate in said activity, and to enter the abovenamed premises and engage in such activities knowing they may be hazardous.  I voluntarily assume full responsibility for any risks of loss, property damage, or personal injury, including death, that may be sustained, or any loss or damage to property, as a result of being engaged in such activities, whether caused by the negligence of Releasee or otherwise.

     This Waiver of Liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

     IN SIGNING THIS RELEASE, I ACKNOWLEDGE AND REPRESENT THAT I have read the foregoing Waiver of Liability, understand it and sign it voluntarily as my own free act and deed; no oral representations, statements, or inducements, apart from the foregoing written agreement, have been made; I am at least eighteen (18) years of age and fully competent; and I execute this Waiver for full, adequate, and complete consideration fully intending to be bound by same. 

June 13, 2021

COVID-19 Addendum to Kickboxing Keene, LLC Release Waiver

Hold Harmless & Indemnification Agreement

This waiver of liability also applies to the risk of contracting COVID-19 while upon the premises, or entering or leaving the premises.

Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19. The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people.

Kickboxing Keene, LLC in Keene, NH (“KBK”) has put in place preventative measures to reduce the spread of COVID-19; however, KBK cannot guarantee that you will not become infected with COVID-19. Further, attending KBK could increase your risk of contracting COVID-19.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by attending KBK and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at KBK may result from the actions, omissions, or negligence of myself and others, including, but not limited to, KBK employees, volunteers, and program participants and their families.

I Agree

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself or underage children (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my attendance at KBK.  On my behalf, I hereby release, covenant not to sue, discharge, and hold harmless the KBK, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of KBK, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during or after participation in any KBK program.

June 13, 2021

First Participant's Name

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
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*
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!