waiver | williamsburg-mma

Williamsburg MMA Waiver

First Name

Last Name

Date of Birth

Do you have a doctor’s permit to participate in intense physical activities?

Yes

Please specify anything we should know about

Initials

I declare that the info I’ve provided is accurate & complete

THE STUDENT (IF MINOR, THE PARENT OR GUARDIAN) RECOGNIZES THE FACT THAT THERE IS CERTAIN ELEMENT OF RISK INHERENT IN THE COURSE HE/SHE IS ABOUT TO UNDERTAKE AND THE ACTIVITIES WHICH HE/SHE WILL PERFORM IN RELATION THERETO AND KNOWING THIS, HEREBY ASSUMES ALL RISK. FURTHER, THE STUDENT RELEASES, DISMISSES AND FOREVER DISCHARGES ROGER MAMEDOV AND ANY OTHER INSTRUCTORS OR MEMBERS IN WILLIAMSBURG MMA FROM AND AGAINST ANY LIABILITY FOR INJURIES, ILLNESS, DAMAGE OR PHYSICAL DEFECTS WHICH MAY RESULT FROM THE STUDENT ENGAGING IN THIS COURSE. THE STUDENT HEREBY AGREES TO REFRAIN FROM INSTITUTING, PRESSING OR IN ANY WAY AIDING ANY CLAIM, DEMAND OF ACTION OR CAUSE OF ACTION FOR DAMAGES, COSTS, LOSS OF SERVICE, EXPENSES OR COMPENSATION FOR OR ON ACCOUNT OF ANY SUCH INJURIES.

Thanks for submitting!