Loyalist Martial Arts Academy Waiver

Waiver For? MySelf My Child/Dependent



 
How did you Hear About Us?
Do you have any Medical Concerns?

No/Yes(Please List) Yes No

(if yes, you must submit a doctor's note specifically stating you are fit to participate in a high intensity fitness workout)
Please list your medical concerns

I confirm that I am the legal guardian and authorize him/her to join Loyalist Martial Arts Academy.
RELEASE OF CLAIMS ARISING FROM ACCIDENT


IN SIGNING THIS DOCUMENT, I ACKNOWLEDGE THAT I AM IN THE PROPER PHYSICAL CONDITION TO PARTICIPATE
IN MARTIAL ARTS CLASSES AND I FURTHER ACKNOWLEDGE THAT I HAVE INSPECTED THE LOYALIST MARTIAL
ARTS ACADEMY’S FACILITIES AND AGREE THAT THEY ARE SUITABLE AND SAFE FOR THE MARTIAL ARTS CLASSES.

 TERMS OF MEMBERSHIP
DURING THE TERM OF MY MEMBERSHIP, I AGREE TO COMPLY WITH THE RULES ESTABLISHED FROM TIME TO TIME
BY LOYALIST MARTIAL ARTS ACADEMY, AND MY INSTRUCTORS TO ENSURE THAT THE CLASSES ARE ORDERLY, SAFE
AND FUN FOR EVERYONE. I UNDERSTAND AND AGREE THAT FAILURE TO FOLLOW THE RULES AND DIRECTIONS OF MY
INSTRUCTORS COULD DISRUPT THE CLASS AND ALSO COULD RESULT IN SERIOUS INJURY TO OTHER PARTICIPANTS.
THEREFORE, I AGREE THAT AT ANY TIME ANY INSTRUCTOR OR ANY OTHER MEMBER OF LOYALIST MARTIAL ARTS
ACADEMY, STAFF HAS THE RIGHT TO IMMEDIATELY, IN THEIR SOLE DISCRETION, TERMINATE MY MEMBERSHIP, WITHOUT
REFUND OF PRE-PAID MEMBERSHIP FEES.

PERSONAL INJURY
I AM WAIVING THE RIGHT TO BRING A LAWSUIT, TO RECOVER COMPENSATION, OR TO OBTAIN ANY OTHER REMEDY FOR
ANY INJURY OR THE DEATH, DAMAGE OR LOSS OF PROPERTY, OR ACCIDENT OF ANY KIND ARISING OUT OF MY MARTIAL
ARTS CLASSES WITH LOYALIST MARTIAL ARTS ACADEMY.

 DEMONSTRATIONS AND TRAVEL
I UNDERSTAND THAT AS A MEMBER OF LOYALIST MARTIAL ARTS ACADEMY, MAY HAVE THE OPPORTUNITY TO TRAVEL TO
COMPETITIONS OR OTHERWISE DEMONSTRATE THEIR MARTIAL ARTS SKILL OUTSIDE LOYALIST MARTIAL ARTS ACADEMY
PREMISES. MY WAIVER AS OUTLINED IN PARAGRAPH V. ABOVE, SHALL ALSO INCLUDE ANY INJURY, DEATH, OR OTHER LOSS
THAT MAY OCCUR AT ANY POINT DURING A TRIP OR EVENT OUTSIDE LOYALIST MARTIAL ARTS ACADEMY PREMISES. MY
WAIVER AS OUTLINED IN PARAGRAPH V ABOVE, SHALL ALSO INCLUDE ANY PERSONAL INJURY, DEATH OR OTHER LOSS THAT
MAY OCCUR AT ANY POINT DURING A TRIP OR EVENT OUTSIDE LOYALIST MARTIAL ARTS ACADEMY PREMISES, INCLUDING,
BUT NOT LIMITED TO, ALL TRAVEL TO AND FROM SUCH EVENTS, AND ANY INJURY SUFFERED DURING ANY NON-MARTIAL
ARTS ACTIVITIES.

PHOTO/VIDEO/RECORDING RELEASE
I GIVE PERMISSION FOR THE USE, PUBLICATION AND OTHER DISPLAY, INCLUDING ADVERTISEMENTS, OF PHOTOS, VIDEO
AND OTHER RECORDINGS TAKEN OF ME WHILE I AM A MEMBER OF LOYALIST MARTIAL ARTS ACADEMY. I UNDERSTAND
THAT I WILL NOT BE COMPENSATED IN ANY WAY FOR ANY PHOTO, VIDEO, OR OTHER RECORDING USED, PUBLISHED OR
DISPLAYED BY LOYALIST MARTIAL ARTS ACADEMY, OR OTHERS.

RELEASE AND INDEMNITY
I HEREBY AGREE TO RELEASE, INDEMNIFY AND HOLD HARMLESS LOYALIST MARTIAL ARTS ACADEMY, INCLUDING ITS
AGENTS, OWNERS, OFFICERS, DIRECTORS, SHAREHOLDERS, VOLUNTEERS, EMPLOYEES, CHAPERONES AND ALL OTHER
PERSONS OR ENTITIES ACTING IN ANY CAPACITY ON BEHALF OF LOYALIST MARTIAL ARTS ACADEMY, FROM ANY CAUSE OF
ACTION, CLAIMS OR DEMANDS WHATSOEVER, HOWEVER CAUSED, INCLUDING, WITHOUT LIMITING THE GENERALITY OF
THE FOREGOING, ANY CLAIMS WHICH ARE CONNECTED WITH: (I) MY PARTICIPATION IN MARTIAL ARTS CLASSES, (II) MY
USE OF LOYALIST MARTIAL ARTS ACADEMY’S FACILITIES; AND (III) USE OF PHOTOGRAPHS, VIDEOS OR OTHER RECORDINGS
TAKEN OF ME AND INCLUDING ANY SUCH CLAIMS WHICH ALLEGE NEGLIGENT ACTS OR OMISSIONS BY ANY OF THE PERSONS
LISTED IN THIS PARAGRAPH. I AGREE THAT THIS WAIVER, INDEMNITY AND RELEASE OF LIABILITY IS BINDING UPON MY
HEIRS, ASSIGNS, PERSONAL REPRESENTATIVES AND ESTATE.

 PRIVACY - COLLECTION OF PERSONAL INFORMATION
LOYALIST MARTIAL ARTS ACADEMY HAS COLLECTED THE PERSONAL INFORMATION LISTED IN THIS APPLICATION FOR
THE FOLLOWING REASONS: I) TO BE ABLE TO CONTACT THE APPLICANTS REGARDING LOYALIST MARTIAL ARTS ACADEMY
CLASSES, TRIALS, AND OTHER RELATED ACTIVITIES; II) TO BE ABLE TO COLLECT PAYMENT OF THE MEMBERSHIP FEES, INCLUDING THE
RELEASE OF THE INFORMATION TO PROFESSIONAL PAYMENT SERVICES, THE COMPANY THAT PROCESSES THE PAYMENT OF
THE MEMBERSHIP FEES ON AN INSTALLMENT BASIS; AND III) TO TRY TO PREVENT INJURY TO APPLICANTS BY BEING AWARE OF
ANY HEALTH CONDITIONS THAT COULD AFFECT THEIR PARTICIPATION. BY SIGNING THIS APPLICATION, I AGREE TO ALLOW
LOYALIST MARTIAL ARTS ACADEMY TO COLLECT, USE AND DISCLOSE MY PERSONAL INFORMATION FOR THESE PURPOSE.

Signature Here Please







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