Membership sign up.

Participants Name: ___________________________________________________________________

Address: ___________________________________________ City: __________________________

State: ________________ Zip: ___________________ Email: ______________________________

Phone: ____________________ Emergency Contact (Name and Phone): ________________________________

I hereby WAIVE AND RELEASE Academy 440 LLC and all associated companies, entities, owners, personnel, or employees from liability pertaining to the matters set forth below. I understand by signing this waiver and release, I expressly and willingly agree to assume complete responsibility for any risk of injury from the below related activities. On behalf of myself, my assigns, and next of kin, I waive all claims for damages, injuries, and death to me or my property that I may have against the above named Released Parties relating to such activities. I understand that the activities that I will participate are inherently dangerous and may cause serious injury, including bodily injury, and/or death. By this waiver, I assume any risk, and take full responsibility and waive any and all claims of personal injury, including severe bodily injury, damage to personal property, and death relating to all activities associated with Academy 440 LLC including but not limited to receiving lessons at the facility or off site, using the facility and its equipment, practicing and engaging in martial arts activities, included but not limited to Brazilian Jiu-Jitsu, Kickboxing, Boxing, Wrestling, Yoga, Pilates, Submission Wrestling, Weapons Training, Weight-Lifting, and related activities on and off academy premises. If I am injured from said activities, I will not hold the Released Parties responsible even if the injuries were caused by negligence on my part or the Released Party, or any other party or affiliates with the above named Released Parties.

I further attest I do not have any physical limitations, physical ailments, physical or mental disabilities that would limit me from safely participating in the above mentioned activities. I understand that Academy 440 LLC has urged me to obtain a medical and physical examination from a doctor prior to participating in above mentioned activities. I HAVE READ AND FULLY AGREE TO THE TERMS OF THIS WAIVER AND RELEASE. I UNDERSTAND AND CONFIRM THAT BY SIGNING THIS WAIVER AND RELEASE I HAVE GIVEN UP CONSIDERABLE FUTURE LEGAL RIGHTS. I HAVE SIGNED THIS WAIVER FREELY, VOLUNTARILY, AND UNDER NO DURESS, OR THREAT OF DURESS WITHOUT INDUCEMENT, PROMIS OR GUARANTEE BEING COMMUNICATED TO ME. MY SIGNATURE IS PROOF OF MY INTENTION TO EXECUTE A COMPLETE AND UNCONDITIONAL WAIVER AND RELEASE LIABILITY TO THE FULLEST EXTENT OF THE LAW. I AM 18 YEARS OF AGE OR OLDER AND MENTALLY COMPETENT TO ENTER INTO AND GRANT THIS WAIVER.

I grant permission to Academy 440 LLC and its agents, employees or assigns, the right to use the photographs taken for use in any publication such as advertising, direct mail, brochures, newsletters, magazines, etc, and to use the photographs on display boards, or other materials. I waive the right to inspect or approve the finished products, images, and waive any right to royalties or other compensations.

This is a binding contract that is intended to provide a comprehensive release of liability, but is not intended to assert any defenses that are prohibited by law. If any part of this contract is deemed unenforceable, all other parts shall be given full force and effect.

PARTICIPANT’S PRINTED NAME                           PARTICIPANT’S SIGNATURE DATE

PARENTS AND GUARDIANS (if participant is under 18 years of age)

If the participant is a minor under 18 years of age, parent(s) and/or guardian(s) must sign in addition to the participant signing above. If a second parent signature is not possible, the first parent/guardian certifies that the second parent/guardian has authorized participant to pursue this activity and second parent/guardian agrees to all items stipulated above in the release of liability and indemnification.

If the participant is a minor, the parent(s)/guardian(s) agree to assume all liability and to HOLD HARMLESS AND INDEMNIFY Academy 440 LLC against any actions brought by the minor participant against Academy 440 LLC. The parent(s)/guardian(s) also accepts responsibility for any and all medical expenses incurred by the participant.