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Impact Martial Arts

Member Information

Acknowledgement of Risks, Injury & Obligations

I acknowledge that the activity I am to undertake is a dangerous activity and that participating in it I am exposed to certain risks. I acknowledge and understand that whilst participating in such activity:

●     I may be injured, physically or mentally, or may die;

●     My personal property may be lost or damaged;

●     Other persons participating in such activity may cause me injury or may damage my property;

●     I may cause injury to other persons or damage their property;

●     The conditions in which the activity is conducted may vary without warning;

●     I may be injured or die or suffer damage to my property as a result of negligence or breach of contract of Impact Martial Arts;

●     There may be no inadequate facilities for treatment or transport of me if i am injured;

●     I assume the risk of and responsibility for any injury, death or property damage resulting from my participation in the activity.

Release and Indemnity

I participate in the activity at my sole risk and responsibility. I release, indemnity and hold harmless Impact Martial Arts, it’s servants and agents, from and against all and any actions or claims which may be made by me or on my behalf or by any parties for or in respect of or arising out of any injury, loss, damage or death caused to me or my property whether negligence, breach of contract or in any way whatsoever.

Administration

●      Appropriate clothing, footwear & a shirt must be worn at all times while in the gym facility.

●      Memberships are not refundable or transferable.

●      All weights and equipment must be put back after use.

●      Photo ID cards (ie: driver license or student card) must be carried and shown on request.

●      Shared gym access with a non member will result in forfeiture of membership effective immediately.

●      Each gym member must respect other gym users and behave in an appropriate manner at all times.

●      Impact staff reserves the right to rescind the rights of members not complying with the terms and conditions of the membership.

●      Anyone under the age of 16 must be accompanied by an adult at all times within the gym.

●      If purchasing personal training sessions, I understand that the sessions are non-refundable and non-transferable

I have read and agree with all of the above and understand that the above applies to all Impact Martial Arts and Conditioning Martial Arts locations.

Today's Date: May 19, 2024


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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
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:*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

Emergency Contact's Relation to Participant
Do you have any martial arts experience? if so what

Click to customize text box label *
What martial art are you interested in?
Click to customize drop-down*
When will be your first class?

Click to customize date box label
Any Questions
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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