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WAIVER + CONTACT DETAILS 

All those who train at London Fight Factory automatically become members for the duration of their time with us.  We use the form below to ensure you are aware of key pieces of information - such as the Assumption of Risk. We also use the contact details you give us for operational reasons. 

DISCLAIMER 

Assumption of Risk

Those participating in any martial arts class and/or training session at London Fight Factory are deemed to have knowledge of and assume the inherent risks and otherwise which include but are in no way limited to risks associated with exertion and taking part in contact sports. Those training at London Fight Factory are also deemed to have knowledge of and assume all inherent risks and otherwise including but not limited to the potential short term and longer-term complications related to Coronavirus or any mutation or variation. 

Please sign below to indicate you understand this and understand and accept the conditions below 

I understand the risks associated with training at London Fight Factory inherent and otherwise, which include, but are in no way limited to, risks associated with exertion and taking part in contact sports. I understand the risk of injury from the activities involved may be significant. I understand and acknowledge that London Fight Factory is in no way making any representation as to any participant's physical ability to participate in this activity. I have no known health problems or medical conditions which could in any way be exacerbated by the activities that I choose to participate in. I assume all health risks associated with such activities.

I hereby acknowledge, confirm and agree that, at all times whilst training and being present at London Fight Factory, I am doing so at my own risk and will exercise the highest degree of care and caution for my own personal health and safety and the health and safety of others.

London Fight Factory shall not be liable for any damages arising from personal injuries sustained or illnesses contracted by me when training or being present at London Fight Factory. I agree to assume and bear all risks of illnesses, injuries or damages to my person or personal property sustained while doing so whether by natural occurrence, my own acts or the acts of others. I hereby release London Fight Factory, their officers, agents, members, other participants, successors and assigns as well as any other person or entity acting in any capacity on its behalf, from all claims, demands, damages, rights of action or causes of action or liability for any such personal illness, injury or property damage that I may incur.

If under 18 years of age, this form must be co-signed by a parent or guardian

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Age: *
Do you have any medical conditions and/or injuries your instructor/s should be aware of? If so, please state them here and - please note - it is also your responsibility to highlight and discuss them with your instructor/s.*
No
Yes

Please list and discuss with your instructor/s:
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

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

Age: *
Do you have any medical conditions and/or injuries your instructor/s should be aware of? If so, please state them here and - please note - it is also your responsibility to highlight and discuss them with your instructor/s.*
No
Yes

Please list and discuss with your instructor/s:
Second Participant's Signature*
Third Participant's Name

First Name*

Middle Name

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

Age: *
Do you have any medical conditions and/or injuries your instructor/s should be aware of? If so, please state them here and - please note - it is also your responsibility to highlight and discuss them with your instructor/s.*
No
Yes

Please list and discuss with your instructor/s:
Third Participant's Signature*
Fourth Participant's Name

First Name*

Middle Name

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

Age: *
Do you have any medical conditions and/or injuries your instructor/s should be aware of? If so, please state them here and - please note - it is also your responsibility to highlight and discuss them with your instructor/s.*
No
Yes

Please list and discuss with your instructor/s:
Fourth Participant's Signature*
Fifth Participant's Name

First Name*

Middle Name

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

Age: *
Do you have any medical conditions and/or injuries your instructor/s should be aware of? If so, please state them here and - please note - it is also your responsibility to highlight and discuss them with your instructor/s.*
No
Yes

Please list and discuss with your instructor/s:
Fifth Participant's Signature*
Sixth Participant's Name

First Name*

Middle Name

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

Age: *
Do you have any medical conditions and/or injuries your instructor/s should be aware of? If so, please state them here and - please note - it is also your responsibility to highlight and discuss them with your instructor/s.*
No
Yes

Please list and discuss with your instructor/s:
Sixth Participant's Signature*
Seventh Participant's Name

First Name*

Middle Name

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

Age: *
Do you have any medical conditions and/or injuries your instructor/s should be aware of? If so, please state them here and - please note - it is also your responsibility to highlight and discuss them with your instructor/s.*
No
Yes

Please list and discuss with your instructor/s:
Seventh Participant's Signature*
Eighth Participant's Name

First Name*

Middle Name

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

Age: *
Do you have any medical conditions and/or injuries your instructor/s should be aware of? If so, please state them here and - please note - it is also your responsibility to highlight and discuss them with your instructor/s.*
No
Yes

Please list and discuss with your instructor/s:
Eighth Participant's Signature*
Ninth Participant's Name

First Name*

Middle Name

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

Age: *
Do you have any medical conditions and/or injuries your instructor/s should be aware of? If so, please state them here and - please note - it is also your responsibility to highlight and discuss them with your instructor/s.*
No
Yes

Please list and discuss with your instructor/s:
Ninth Participant's Signature*
Tenth Participant's Name

First Name*

Middle Name

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

Age: *
Do you have any medical conditions and/or injuries your instructor/s should be aware of? If so, please state them here and - please note - it is also your responsibility to highlight and discuss them with your instructor/s.*
No
Yes

Please list and discuss with your instructor/s:
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

In case of emergency who should we notify? 


Emergency Contact Name: *

Emergency Contact Relationship: *

Emergency Contact Phone: *
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 Information

Age: *
Do you have any medical conditions and/or injuries your instructor/s should be aware of? If so, please state them here and - please note - it is also your responsibility to highlight and discuss them with your instructor/s.*
No
Yes

Please list and discuss with your instructor/s:
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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