L I A B I L I T Y
F O R M
- STUDENT INFORMATION (PLEASE WRITE LEGIBLY)
STUDENT’S NAME:________________________________________ PARENT’S NAME (if applicable):_________________________________
DOB:____/____/_____
AGE:________
GENDER: Male / Female
OCCUPATION:__________________________________________
ADDRESS:______________________________________________________________
CITY:___________________________
STATE:_______
PHONE #:_____________________________________
ZIP CODE:________________
E-MAIL:________________________________________________________
EMERGENCY CONTACT
NAME:____________________________________
RELATIONSHIP:_________________________________
CONTACT #:____________________________________________
LIABILITY/APPEARANCE RELEASE, WAIVER, DISCHARGE AND COVENANT NOT TO SUE
THIS IS A RELEASE OF YOUR RIGHTS. READ CAREFULLY BEFORE SIGNING.
This is a legally binding Liability Release, waiver, discharge and covenant not to sue (the “Release”), made by me, the undersigned, to Fight Fundamentals LLC dba M3 Fight and Fitness, to the instructors of M3 Fight & Fitness, and to the members of M3 Fight and Fitness (the “Members”).
I,_____________________________________________________, fully recognize that there are dangers and risks to which I may be exposed by
joining M3 Fight & Fitness and participating in Brazilian Jiu Jitsu/Muay Thai/Kickboxing/Wrestling/Judo/Boxing/Mixed Martial Arts/Physical
Conditioning, which involve strenuous physical activity and extensive physical contact with other people equipment, and on the mat, including but not
limited to joint locks, throws, chokes, strikes, kicks, blocks, ground fighting, and other similar activity. INITIALS__________
With full understanding of the risks involved and despite this Release, I am voluntarily joining M3 Fight & Fitness and I am willing to participate in
Brazilian Jiu Jitsu/Muay Thai/Wrestling/Judo/Boxing/Mixed Martial Arts/Physical Conditioning programs. INITIALS__________
I, therefore agree to assume and take upon myself all of the risks and responsibilities in any way associated with this activity. In consideration of and
in return for services, facilities, and the other assistance provided to me by M3 Fight & Fitness, the Instructors, and the other Members in this activity, I
release M3 Fight & Fitness, its agents, the Instructors and the Members from any and all liability, claims and actions that may arise from injury or harm
to me, from my death or from damage to my property in connection with this activity. I understand that this Release covers liability, claims and actions
caused entirely or in part by any acts or failures to act by M3 Fight & Fitness, its agents, the Instructors and the Members, including but not limited to
negligence, mistake, or failure to supervise. INITIALS__________
I also hereby irrevocably grant to M3 Fight & Fitness the right to tape and photograph me, and record my voice, during and in connection with my
training, any competition, and results and school functions. I understand and warrant that you shall be the exclusive owner of the results and proceeds
of such taping, photography and recording with the limited right, but not the obligation, throughout the world in all media in perpetuity, to copyright, to
use in connection with the promotion and instruction of M3 Fight & Fitness. INITIALS__________
I recognize that this Release means I am giving up, among other things, the rights to sue M3 Fight & Fitness, its agents, the Instructors and Members
for injuries, damages, or losses I may incur while participating in these activities. I also understand that this Release binds my heirs, executers,
administrators, and assigns, as well as myself. INITIALS__________
I have read the entire Release; I fully understand it and I agree to be legally bound by it.
____________________________________________________________
RELEASER’S SIGNATURE or PARENT GUARDIAN’S SIGNATURE (if minor)
____________________________
DATE
_______________________________________________________
PRINT NAME
- FOR OFFICE USE ONLY FIRST CLASS_____________________________________TIME____________________________
STAFF INITIALS___________
2613 Honolulu Avenue, Montrose, CA, 91020 / (818) 564-7839 / www.M3Fight.com