Please complete this form prior to your first class at 10th Planet Tempe.
PERSONAL INFORMATION
Name: {Name}
DOB: {dob}
Address: {address}
Phone: {phone}
Emergency Contact: {contact_name}
Emergency Phone: {contact_phone}
Relation: {contact_relation}
Date: {sign_date}
ASSUMPTION OF RISK, WAIVER OF CLAIMS AND INDEMNIFICATION AGREEMENT
To the best of my knowledge, I am an in good physical & mental health and fully able to participate in and classes or activities offered by 10th Planet Tempe. I understand that participation in martial arts, Brazilian Jiu-Jitsu, and related activities at 10th Planet Tempe involves inherent risks including but not limited to:
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- Risk of injury from physical contact with other participants
- Risk of injury from equipment, mats, and training surfaces
- Risk of muscle strains, sprains, fractures, and other injuries
- Risk of cuts, bruises, and abrasions
- Risk of more serious injuries including concussion or death
ACKNOWLEDGMENT OF RISK: I acknowledge that I have been informed of and understand the nature of martial arts training and the inherent risks involved. I voluntarily assume all such risks.
RELEASE OF LIABILITY: In consideration for being permitted to participate in activities at 10th Planet Tempe, I hereby release, waive, discharge and covenant not to sue 10th Planet Tempe, its owners, instructors, employees, agents, affiliates and representatives from any and all liability, claims, demands, actions or rights of action for damages, losses, or injuries that may occur during my participation.
INDEMNIFICATION: I agree to indemnify and hold harmless 10th Planet Tempe from any loss, liability, damage or cost incurred as a result of my participation in activities.
MEDICAL TREATMENT: I consent to receive medical treatment which may be deemed advisable in the event of injury while participating in activities. I understand that I am responsible for all medical costs.
PHOTOGRAPHY/VIDEO CONSENT: I grant permission for 10th Planet Tempe to use photographs or videos of me taken during activities for promotional purposes.
BINDING AGREEMENT: This agreement shall be binding upon my heirs, estate, assigns, and personal representatives. This agreement shall be governed by Arizona law.
ENTIRE AGREEMENT: This document contains the entire agreement between the parties and supersedes any prior understanding or representation of any kind.
Waiver and Release of Liability Agreement
I have read and fully understand this waiver and release agreement. I voluntarily agree to its terms and conditions.
I confirm that I am 18 years of age or older, or if under 18, this form has been signed by my parent or guardian.
I consent to the use of photographs and videos for promotional purposes.
Acknowledgment
By signing and submitting this form, I acknowledge that I have read, understood, and agree to all terms and conditions outlined in this waiver.
10th Planet Tempe
