Self Defense Registration
Participant Information and Liability Form
Best Way to Contact:
Emergency Contact Phone:
How did you hear about us?
Please indicate the training you are interested in:
Mixed Martial Arts
Why are you interested in joining G.I.R.L.S. Gym?
Do you know any of our current members?
What is your fitness level?
Do you have any health limitations?
Do you have previous experience? Please provide details.
Do you currently train with any other martial arts schools or groups? If so, where and what is the status of your relationship with them?
What other sports / physical activities do you participate in?
Have you been convicted of any violent crimes?
If so, please provide details.
Additional comments or concerns:
In consideration of being allowed to participate in any of G.I.R.L.S. Gym programs and / or related activities. I acknowledge and agree to the following disclosures:
1. Risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist.
2. I acknowledge martial arts may be dangerous and I accept and assume such risks, both known and unknown, and assume full responsibility for my participation: I am aware that martial arts in general, involves inherent risks.
3. I willingly agree to release G.I.R.L.S. Gym and/or any of its representatives from responsibility and waive all my rights to take any legal action against them.
4. Promotional Use of Images: I hereby agree that G.I.R.L.S. Gym may use film or photographic records of classes & events for promotional and/or commercial purposes without compensation to me.
6. I agree to replace and / or compensate for all or any equipment damaged due to my negligence.
7. I, for myself and on behalf of my heirs assigned, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS, G.I.R.L.S. Gym, their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners of premises used to conduct the event (“Releases”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damages to person property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASES OR OTHERWISE, to the fullest extent permitted by the law.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARY WITHOUT ANY INDUCEMENT.
BY TYPING MY NAME IN THE SPACE LABELED “SIGNATURE” BELOW (WHICH SHALL CONSTITUTE MY SIGNATURE) AND BY CLICKING ON THE “I AGREE” BUTTON BELOW, I CONFIRM THAT I HAVE READ AND UNDERSTOOD THE DISCLOSURES SET FORTH ABOVE.
Members Only Site