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Assumption of Risk and Waiver of Liability Relating to COVID-19

 

                      

 

COVID-19 is a highly infectious disease that can be spread by person-to person contact.  As a result, federal, state, local governments and health agencies have recommended social distancing and have, in many locations, prohibited the congregation of groups of people.

According to the CDC and World Health Organization, symptoms of COVID-19 vary and can range from mild to severe illness, but some people may not show any symptoms at all.  Symptoms of COVID-19 can include fever, chills, cough, body aches, fatigue, shortness of breath, sore throat, congestion, or new loss of taste or smell.  People with underlying medical conditions (such as heart/lung/kidney disease or diabetes) and older adults are at an increased risk of more serious complications, but it has been shown that everyone is at risk regardless of age. If you have had any recent COVID-19 related symptoms or have been in close contact with anyone who has COVID-19, we urge you not to participate in the programs at North Jersey Muay Thai Gym or not to attend classes until the illness resolves.  We recommend that you seek medical attention and stay home to prevent the spread of the disease.  Consequently, you should get clearance from your doctor that you can resume training. 

North Jersey Muay Thai Gym, L.L.C. has put in place preventative measures to minimize the spread of COVID-19;  however, North Jersey Muay Thai Gym , L.L.C. cannot guarantee that you or your child(ren) will not become infected with COVID-19.  Further, because the threat of this pandemic is still ongoing, attending North Jersey Muay Thai Gym could increase your risk, and/or your child(ren)’s risk of contracting COVID-19.  

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I and/or my child(ren) may be exposed to or infected by COVID-19 by attending North Jersey Muay Thai Gym 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 North Jersey Muay Thai Gym may result from the actions, omissions, or negligence of myself and others, including, but not limited to, North Jersey Muay Thai employees, volunteers, and program participants and their families.

  I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself or my child(ren) (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my attendance at North Jersey Muay Thai Gym or participation in North Jersey Muay Thai Gym programs.  On my behalf, and on behalf of my child(ren), I hereby release, covenant not to sue, discharge, and hold harmless North Jersey Muay Thai Gym, LLC, 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 the Club, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any North Jersey Muay Thai Gym program.

First Participant's Name

First Name*

Middle Name

Last Name*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
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*
Parent or Guardian's Email Address

Email*

Confirm Email*
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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*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
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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