Victoria Martial Arts


This is a binding legal agreement. As a participant in competitions, programs, activities and events of Victoria

Martial Arts, the undersigned acknowledges and agrees to the following terms:

Description of Risks

1. In consideration of my participation in the competitions, programs, activities and events of [Victoria Martial

Arts], I hereby acknowledge that I am aware of the risks and hazards associated with or related to any such

competitions, programs, activities and events. The risks and hazards include, but are not limited to, injuries


a. Physical contact with the instructor, members, opponents or other boxing/kickboxing participants;

b. Striking members, boxing/kickboxing participants, objects or equipment;

c. Being struck by the instructor, members, boxing/kickboxing participations, objects or equipment; 

d. Contact, colliding, falling or being struck by other boxing/kickboxing participants, spectators or equipment;

e. Executing strenuous and demanding physical techniques;

f. Vigorous physical exertion, strenuous cardiovascular workouts, rapid movements and quick turns and


g. Exerting and stretching various muscle groups;

h. Dry land training including weights, plyometrics, running and circuit training;

i. Extreme weather and temperature conditioning which may result in heatstroke, sunstroke or hypothermia;

j. Falling or colliding with the ring, walls, stands, equipment or with other boxing/kickboxing participants;

k. Failure to properly use any piece of equipment or from mechanical failure of any piece of equipment;

l. Spinal cord injuries which may render me permanently paralyzed; and

m. Travel to and from competitive events and associated non-competitive events which are an integral parts of

[Victoria Martial Arts] competitions, programs, activities and events.

1. Furthermore, I am aware:

a. That injuries sustained can be severe;

b. That I may experience anxiety while challenge myself during the activities, events and programs;

c. That I may come into close contract with other boxing/kickboxing participants;

d. That my risk of injury is reduced if I follow all the rules established for participations; and

e. That my risk of injury increases as I become fatigued.

Release of Liability and Disclaimer

1. In consideration of [Victoria Martial Arts] allowing me to participate, I agree:

a. That my physical condition has been verified by a medical doctor within the last (6) months;

b. To assume all risks arising out of, associated with or related to my participation and am fully aware of the

nature of these risks;

c. To be solely responsible of any injury, loss or damage that I might sustain while participating; and 

d. To RELEASE and DISCHARGE Victoria Martial Arts and its directors, officers, committee members,

clubs, members, employees, coaches, volunteers, officials, judges, boxing/kickboxing members and participants,

agents and representatives from any and all liability, for any and all claims, demands, actions, judgements,

executions and costs that might arise out of my participating or membership, even though any such risks, injuries,

loss, damage, claims, demands, actions or costs may have been caused by any manner whatsoever, including but not

limited to, the negligence of [Victoria Martial Arts].


1. I acknowledge that I have read and understand this agreement, that I have executed this agreement

voluntarily, and that this agreement is to be binding upon myself, my heirs, executors, administrators and


Please select who will be participating...
First Participant's Name

First Name*

Middle Name

Last Name*

First Participant's Date of Birth*
First Participant's Signature*
Parent or Guardian's Email Address


Confirm Email*
Check to receive information, news, and discounts by e-mail from Victoria Martial Arts.
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*

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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