Loading...

Back to Basics Waiver

The Student hereby waives any and all claims against any and all persons associated with Back to Basics LLC (BTB). The Student understands that they are participating in a martial art, which incorporates body contact. The student understands that this form of martial arts involves practices, which could potentially cause serious injury or death. The student understands that body contact is involved in this form of martial art, which results in skin-to-skin contact with other students, staff, and equipment. Skin-to-skin contact may result in contracting skin born infections. The student assumes the risk of such activities and assumes full responsibility for all actions connected to the above activity. The student understand the risks of participating in this form of martial arts training and fitness training and hereby releases BTB and all of its owners, agents, employees and associates of any and all liability, claims, demands, actions, medical bills, and causes of action whatsoever that may be sustained by the undersigned by participating in this form of training. The student also represents and warrants to BTB he/she is in good physical condition and knows of no reason why they, the Student, cannot train in this form of martial arts. 

The Student acknowledges that in case of emergency, the Student authorizes any licensed medical personnel to provide medical assistance deemed necessary and the Student agrees to bear the expense of any such treatment.

As additional consideration for training at BTB, the Student agrees that Student’s attendance and/or performance at the gym and at outside events including seminars and competitions may be photographed, filmed and or/taped and used by BTB for marketing purposes. The Student authorizes the use of their image and voice in any media whatsoever and waives any requirement to compensate him/her for said use. This authorization shall continue beyond the termination of Student’s training at BTB.

Valuables and Personal Property: BTB shall not be liable for the loss of or theft of, or damage to, the personal property of the Student or guests, including items left in lockers, or elsewhere in the BTB Gym.

The Student understands that disobeying the rules and requirements of BTB may, at the instructor’s discretion, result in the Student’s suspension or expulsion from class with no refund.

By signing this agreement, the undersigned Student hereby acknowledges and represents: he/she has read the foregoing release, understands it and signed it voluntarily; that he/she is over 18 years of age and of sound mind. If under 18, parent/legal guardian in signing this release agrees to all of its terms and conditions. the body of your waiver here.

First Participant's Name
First Name*
Middle Name
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant's Signature*
Second Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.
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*
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!