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Samurai Spirit Jiu Jitsu
Liability Waiver
First name
Last name
Date of Birth
Parent's Name (If Minor)
Email
Code
Phone
Address
Emergency Contact - Name:
Email:
Phone
Any Medical Conditions? Please specify anything we should know about
I declare that the info I’ve provided is accurate & complete
I agree to abide by the rules of the gym as posted and amended, and to follow any instructions issued by employees or personnel. I agree to use the premises and the equipment provided in a courteous and thoughtful manner and to treat other members and gym staff with respect, to ensure that all patrons can use the gym without compromise to their health and safety, or under risk of injury. In consideration of my being permitted to become a member of Samurai Spirit Jiu Jitsu, myself, my heirs, executors, administrators, and assigns do hereby release and forever discharge, waive and save harmless, protect and keep indemnified, Samurai Spirit Jiu Jitsu and all their respective agents, employees and representatives from, and against any and all kinds of actions, claims, costs, expenses, and demands in respect to death, injury, loss or damage, to my person or property however caused, and arising out of my being permitted to attend all in any way prior to, during subsequent programs and/or activities as a member.
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