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Rogue Island Combat

1200 Bald Hill Road

Warwick, RI 02886

(315) 982-1639

Waiver and Release of Liability

IN CONSIDERATION OF THE SERVICES OF ROGUE ISLAND COMBAT LLC, THEIR AGENTS, VOLUNTEERS, PARTICIPANTS, EMPLOYEES, OWNERS AND ALL ENTITIES ACTING ON THEIR BEHALF COLLECTIVELY REFERRED TO AS ROGUE ISLAND HEREAFTER, I HEREAFTER AGREE TO RELEASE AND DISCHARGE ROGUE ISLAND COMBAT ON BEHALF OF MYSELF, MY CHILDREN, MY PARENTS, HEIRS, ASSIGNS AND ESTATE AS FOLLOWS:

A. I KNOW THE STUDY AND TRAINING OF MARTIAL ARTS LIKE, KUN KHMER, MUAY THAI, MUAY LAO, FITNESS ACTIVITIES, AND SELF DEFENSE ENTAILS KNOWN UNANTICIPATED RISKS WHICH COULD RESULT IN PHYSICAL OR EMOTIONAL INJURY; PARALYSIS, DEATH, OR DAMAGE TO MYSELF, TO PROPERTY OR THIRD PARTIES. I UNDERSTAND THAT SUCH RISK SIMPLY CANNOT BE ELIMINATED; SOME OF THESE RISKS INCLUDE BUT ARE NOT LIMITED TO HEART ATTACK, BRUISES, BROKEN BONES, OR OTHER SERIOUS INJURY.

B. I AGREE AND PROMISE TO ACCEPT AND ASSUME ALL RISKS EXISTING IN THIS ACTIVITY. MY PARTICIPATION IS COMPLETELY VOLUNTARY AND I WANT TO PARTICIPATE DESPITE THE KNOWN AND UNKNOWN RISKS.

C. I RECOGNIZE THAT PARTICIPATION INCLUDES BODY CONTACT AND GRABBING OF VARIOUS BODY PARTS.

D. I HEREBY VOLUNTARILY RELEASE, FOREVER DISCHARGE, AND AGREE TO INDEMNIFY AND HOLD HARMLESS ROGUE ISLAND COMBAT FROM AND AND ALL CLAIMS, DEMANDS OR CAUSES OF ACTION, WHICH ARE IN ANY WAY CONNECTED TO MY PARTICIPATION IN THIS ACTIVITY OR USE OF EQUIPMENT, OR FACILITIES INCLUDE ANY SUCH CLAIMS, WHICH ALLEGE NEGLIGENT ACTS OR OMISSIONS OF ROGUE ISLAND COMBAT.

E. SHOULD ROGUE ISLAND COMBAT OR ANY ONE ACTING ON THEIR BEHALF BE REQUIRED TO INCUR ATTORNEY FEES AND COSTS TO ENFORCE THIS AGREEMENT I AGREE TO INDEMNIFY AND HOLD THEM HARMLESS FOR ALL SUCH FEES AND COSTS.

F. I CERTIFY THAT I HAVE ADEQUATE INSURANCE TO COVER ANY INJURY OR DAMAGE I MAY CAUSE OR SUFFER WHILE PARTICIPATING OR ELSE I AGREE TO BEAR THE COSTS OF SUCH PROBLEMS. I FURTHER CERTIFY I HAVE NO MEDICAL CONDITION, WHICH COULD INTERFERE WITH MY SAFETY OR PARTICIPATION IN SUCH ACTIVITY BY ANY SUCH CONDITION. BY SIGNING THIS DOCUMENT, I ACKNOWLEDGE THAT IF ANYONE IS HURT OR PROPERTY IS DAMAGED, I MAY BE FOUND BY A COURT OF LAW TO HAVE WAIVED MY RIGHT TO MAINTAIN A LAWSUIT AGAINST ROGUE ISLAND COMBAT AND ITS EMPLOYEES, AGENTS, VOLUNTEERS, PARTICIPANTS, OR ENTITIES ON THE BASIS OF ANY CLAIM FROM WHICH I HAVE RELEASED THEM HEREIN. I HAVE READ AND COMPLETELY UNDERSTAND THIS DOCUMENT AND I AGREE TO BE BOUND BY ITS TERMS.

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*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

Phone*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
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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*

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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