Because martial arts a be strenuous and subject to risk of serious injury, we urge you to obtain a physical examination from a doctor before participating
1. In consideration of being allowed to participate in Extreme Lacosta MMA Inc training and programs and to the use of its facilities, equipment, and classes, I hereby forever waive, release, and discharge Extreme Lacosta Muay Thal Inc and any of its officers, agents, employees, representatives, executors, owners and leasers of the premises, his or her heirs. next of kin from any and all claims or liabilities for injuries or damages to my person and/or property, including those caused by the negligent act or omission of any of those mentioned or others acting on their behalf, arising out of or connected to personal lessons, classes and the use of any equipment, including home activities, provided by and/or recommended by Extreme Lacosta MMA Inc. (Please initial
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2. have been informed, understand, and am aware that martial arts is a physical contact activity that might result in serious
injury including a permanent disability and a remote chance of death, and that the use of equipment, and exercise and
activities associated with martial arts are potentially dangerous. I also have been informed and am aware that Muay Thai
activities involve a risk and I recognize and understand that such a risk may be due to not only my own action, but also the
actions, inactions or negligence of others, the regulations of participation, or the condition of the premises, or of any of
the equipment used. (Please initial
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3. 1am voluntarily participating in these activities and using equipment with the full knowledge, understanding, and
appreciation of the dangers involved. I hereby agree to expressly assume and accept any and all risks of injury or death.
(Please initial )
4. I do hereby further declare myself to be physically sound and suffering from no condition, impairment, disease, infirmity,
or other illness that would prevent my participation or use of equipment or machinery. I also acknowledge that it has been
recommended that I have permission from a physician to train in martial arts and to have yearly physical examinations and
consultations with my physician as to physical activity, training in martial arts.
5. I acknowledge that I have either had a physical examination and have been given my physician’s permission to participate,
or that I have decided to participate in the activities, programs, training and use of equipment without the approval of my
physician and do hereby assume all responsibility for my participation in said activities, programs, training and use of
equipment. (Please initial )
6. grant permission in case of injury to have a doctor, nurse or athletic trainer or other emergency medical personnel
provide me with medical assistance or treatment for such injury. (Please initial )
7. agree to inspect the facilities, equipment and pairings prior to participation and will immediately inform an instructor if I
believe that anything is unsafe or beyond my capability and if so will not participate. (Please initial )
8. I have entered Martial Arts Training and/or competitions entirely of my own free will and understand the importance of
following the rules of training and competition. (Please Initial )
9. I have been given a copy of the rules and regulations of Extreme Lacosta MMA Inc. and agree to abide by the
instruction given therein. (Please initial )
I have hereby read the above warnings, wavier, release and agreement to participate and I underhand its contents and hereby
sign voluntarily.
