Printable Waiver Form

Shield Martial Arts, LLC

Coastal Ninja Warriors

Participant First Name: 

Participant Last Name:

Street Address:

City:

State:

Zip / Postal Code:

Birthday:

Are there any medical concerns that we should know about that might effect training?

Parent / Guardian Full Name:

Parent / Guardian Phone Number:

Email:

Waiver

SHIELD MARTIAL ARTS LLC., PARTICIPANT AGREEMENT, INDEMNIFICATION, GENERAL RELEASE AND ASSUMPTION (PLEASE READ THIS DOCUMENT CAREFULLY, BY SIGNING IT, YOU ARE GIVING UP YOUR AND/OR YOUR MINOR’S LEGAL RIGHTS) In consideration of being allowed to participate in the services and activities, including, but not limited to, course access, martial arts classes, fitness classes and any other programs/ activities, (collectively “ACTIVITIES”) provided by SHIELD MARTIAL ARTS LLC. and its agents, owners, directors, volunteers, participants, clients, customers, invitees, employees, independent contractors, insurers, facility operators, land and/or premise owners, and any and all other persons and entities acting in any capacity on its behalf (Collectively “SHIELD MARTIAL ARTS”), I, on behalf of myself, and/ or on behalf of my minor child(ren)/ward(s), hereby agree to forever release, indemnify and discharge SHIELD MARTIAL ARTS LLC on my spouse, legal partner, my children, my parents, my guardians, heirs, assigns, personal representatives and estate, and all other persons and entities who could in any way represent me or act on my behalf as follows: (1) RELEASE OF LIABILITY: Despite all known and unknown risks, I hereby expressly and voluntarily remise, release, acquit, satisfy and forever discharge SHIELD MARTIAL ARTS LLC and agree to hold it harmless of and from all, and all manner of action and actions or omission(s), cause and cause of action, suits, debts, dues, sums of money, accounts, reckonings, bonds, bills, specialties, covenants, contracts, controversies, agreement, promises, variances, trespasses, damages, judgments, executions, claims and demands whatsoever, in law or in equity, including but not limited to any and all claims which allege negligent acts and/or omissions committed by SHIELD MARTIAL ARTS, whether the action arises out of any damage, loss, personal injury, or death to me or my child(ren)/ward(s), while participating in or as a result of participating in any of the ACTIVITIES. This Release of Liability, is effective and valid regardless of whether the damage, loss or death is a result of any act or omission on the part of SHIELD MARTIAL ARTS. (2) INDEMNIFICATION: I hereby agree to indemnify and hold harmless from and against any and all losses, liabilities, claims, obligations, costs, damages and/or expenses whatsoever paid, incurred and/or suffered by SHIELD MARTIAL ARTS, including, but not limited to, any and all attorneys’ fees, costs, damages and/or judgments SHIELD MARTIAL ARTS incurs in the event that I or my minor child(ren)/ward(s) cause any injury, damage and or harm to SHIELD MARTIAL ARTS and/or any and all other persons and entities acting in any capacity on behalf of SHIELD MARTIAL ARTS LLC. (3) ATTORNEYS’ FEES: I promise to indemnify SHIELD MARTIAL ARTS LLC for any attorneys’ fees and/or costs incurred to enforce this agreement, including all costs associated with any collection efforts. Further, should any debt and/or judgment accrue in favor of SHIELD MARTIAL ARTS LLC, pre-judgment and post-judgment interest shall accrue thereon at a rate of 18%per annum. (4) PHOTO RELEASE: By entering SHIELD MARTIAL ARTS LLC and participating in the ACTIVITIES, I hereby grant SHIELD MARTIAL ARTS LLC on behalf of myself and on behalf of my child(ren)/ward(s), to the irrevocable right and permission to photograph and/or record me or my child(ren)/ward(s) in connection with SHIELD MARTIAL ARTS and to use the photograph and/or recording for all purposes, including advertising and promotional purposes, in any manner an all media now or hereafter known, in perpetuity throughout the world, without restriction as to alteration. I waive any right to inspect or approve the use of the photograph and/or recording, and acknowledge and agree that the rights granted to this release are without compensation of any kind. I further grant permission and waive any objection to the use of any videographic or photographic images taken by me which may subsequently be posted to public social media Internet sites, or disseminated to the public. I further grant permission and waive any objection to the use of videographic or photographic images taken by me within SHIELD MARTIAL ARTS, which may subsequently be posted to public social media Internet sites, or disseminated to the public. I acknowledge that SHIELD MARTIAL ARTS may, at their discretion, utilized videos or images for business purposes and may do so without any further express consent. (5) TERMS OF AGREEMENT: I understand that this agreement extends forever into the future and will have full force and legal effect each and every time I or my child(ren)ward(s) visit SHIELD MARTIAL ARTS LLC, whether at the current location or any other location or facility. (6) VENUE/ARBITRATION: In the event a lawsuit is filed against SHIELD MARTIAL ARTS LLC, I agree to the sole and exclusive venue of Washington County, I further agree that the substantive law of Rhode Island shall apply to any conflict of law rules. I also agree the parties hereto involving any claim arising out of or relating to a breach of this agreement shall be submitted to and be settled by final and binding arbitration in Washington County, Rhode Island, in accordance with the then current Arbitration Rules of the American Arbitration Association. By signing this document, I understand that I may be found by a court of law to have forever waived my and my child(ren)/ward(s) right to maintain any action against SHIELD MARTIAL ARTS LLC on the basis of any claim from which I have released SHIELD MARTIAL ARTS and any released party herein. I have had a reasonable and sufficient opportunity to read and understand this entire document and consult with legal counsel, or have voluntarily waived my right to do so. I knowingly and voluntarily agree to be bound by all terms and conditions set forth herein. We reserve the right to review your license and/or other forms of ID to verify identity and age. Parent of Legal Guardian Signature (Only 18 or older can sign for themselves)

(SIGN HERE)