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WATERLOO MUAY THAI WAIVER

Release of Liability, Waiver of Claims, and Assumption of Risks

By signing this legal document, you will be giving up certain legal rights, including the right to sue.  PLEASE READ CAREFULLY

NAME: {first_name} 

PERMANENT ADDRESS: {address}

PHONE #: {phone}

ASSUMPTION OF RISK:

I AM AWARE THAT THERE IS POTENTIAL RISK FOR INJURY INVOLVED IN THE TRAINING AND PARTICIPATION OF ANY PHYSICAL ACTIVITY. I am aware that participating in Muay Thai, has many inherent risks including but not limited to:

>    INJURIES: spinal and neurological injuries, head injuries (including concussions), fractures, sprains, strains,

contusions, dislocations, as well as injuries that may result from the administering of medical services by the Waterloo Muay Thai staff (including prophylactic taping, assessment, rehabilitation, and emergency care).

>   EQUIPMENT: any manner of injury resulting from use, misuse, non-use and failure of any personal and Waterloo Muay Thai equipment.

>    TERRAIN: any manner of injury resulting from falls on steep, icy, slippery or uneven terrain and practice surfaces.

>    I freely accept and fully assume all such risks, dangers and hazards, including but not limited to injury through physical activity and/or use of equipment and facilities, and the possibility of personal injury, death, property damages or loss, resulting from my participation in Waterloo Muay Thai classes.

>    I am aware that I should discuss my participation in this activity with my physician to determine the effect on my current health.

>    I understand and agree that Waterloo Muay Thai has the right to ensure the safety of all participants. Any behavioral misconduct can result in immediate removal from Waterloo Muay Thai Classes without monetary compensation at the discretion of Waterloo Muay Thai instructors.

RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT: in consideration of approval to participate in Waterloo Muay Thai classes, I hereby agree as follows:

TO WAIVE ANY AND ALL CLAIM that I have or may in the future have against Waterloo Muay Thai, its directors, Instructors, employees and representatives, and other participants (all of whom are hereinafter collectively referred to as “Releasees”).

TO RELEASE THE RELEASEES from any and all liability for any loss, damage, injury or expense that I may suffer or that my next of kin may suffer as a result of my participation in Muay Thai due to any cause whatsoever, INCLUDING NEGLIGENCE, BREACH OF CONTRACT OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE. I acknowledge my responsibility to ensure my own adequate medical, personal health, dental and accident insurance coverage, as well as protection of my personal possessions.

TO HOLD HARMLESS AND INDEMNIFY THE RELEASEES from any and all liability for any damage to property of, or personal injury to, or costs, any third party, resulting from my participation in Muay Thai.

THIS AGREEMENT shall be effective and binding upon my heirs, next of kin, executors, administrators, assigns or representatives in the event of my death or incapacity.

IN ENTERING INTO THIS AGREEMENT, I am not relying upon any oral or written representations or statements made by the Releasees other than what is set forth in this agreement.

I HAVE READ AND UNDERSTAND THIS AGREEMENT AND I AM AWARE THAT BY SIGNING THIS AGREEMENT I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS OR ASSIGNS MAY HAVE AGAINST THE RELEASE.

Signed date: {sign_date}