We do not share your personal information with anyone.

Loading...

Randy Brown Mantis Boxing Jiu-Jitsu Membership Agreement, Waiver, and Release of Liability


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

MEMBERSHIP TERMS/CONDITIONS

I agree to provide a 30 day cancellation notice upon terminating my membership. Furthermore, I understand that any recurring membership payments due within that 30 day window will be processed. I also understand I am authorized to use any classes I am due within the 30 days following the final payment. Once that 30 days from the last payment is passed I forfeit all remaining classes/credits.


Nor'easter Martial Arts, LLC d.b.a. Randy Brown Mantis Boxing 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 in my membership agreement and provided for me on https://randybrownmantisboxing.com website.


WAIVER

In consideration of being allowed to participate in any way with Nor'easter Martial Arts, LLC, related events and activities, the undersigned acknowledges, appreciates, and agrees that:

  1. The risk of injury and/or illness from the activities involved in the program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce the risk, the risk of serious injury does exist;
    I Agree

     
  2. The risk to have contact with individuals, who have been exposed to and/or have been diagnosed with one or more communicable diseases, including but not limited to COVID-19 or other medical conditions, diseases, or maladies does exist, and it is impossible to eliminate the risk that I could be exposed to and/or become infected through contact with or close proximity with an individual with a communicable disease;
    I Agree

     
  3. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume all full responsibility for my participation;
    I Agree

     
  4. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest coach/instructor/organizer immediately; and
    I Agree

     
  5. I agree to release and hold harmless Nor'easter Martial Arts, LLC, its officers, agents, and employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of the premises used to conduct the training, and events, ("Releasess"), 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 training, 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 Agree

     
  6. 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

     
  7. If an emergency contact, parent, or guardian cannot be contacted in the event of a medical emergency requiring immediate attention, I hereby consent to allow Nor'easter Martial Arts, LLC its officers, agents, and employees 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

     
  8. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, BEFORE ACKNOWLEDGING THE CHECKBOX BELOW, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY AGREEING TO IT ON MY OWN BEHALF OR ON BEHALF OF THE YOUTH PARTICIPANT ASSOCIATED WITH THIS GUARDIAN ACCOUNT, AND I SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
    I Agree

November 21, 2024

 

 

First Participants Name

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

Last Name*
Tenth Participants Date of Birth*
Participants 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*
Emergency Contact

First Name*

Last 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.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle 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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!