Sign our waiver - Cincinnati MMA Academy

Student name

Phone Number

Which program are you booking?

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How did you hear about us?
Former studentReferred by studentWalk inSocial mediaWebsite

What Martial arts are you interested in? (Check all that apply)
Brazilian JiujitsuMMAJeet Kune DoKenpoKaliAikido

Do you have prior martial arts experience? If so, what have you practiced, how long did you practice, and what rank did you achieve?

Do you have any prior injuries?

Rules and Regulations:

As a student, I must faithfully comply with all the rules and safety regulations of the Academy. I further understand that all the classes are supervised by qualified personnel and that strict observation of safety regulation will largely preclude the possibility of accident and injury. Furthermore I am physically and mentally fit to participate in a course of martial art instruction and free of any communicable/infectious disease(s)
Acknowledge

Medical Release:

In the event of an emergency, Student or Guardian hereby authorizes transportation and licensed personnel to perform any accepted medical procedures on the Student deemed necessary or advisable, and agrees to bear the expense of such transportation or procedures.
Acknowledge

Release of Liability:

Martial arts instruction and self defense courses offered by Premier Shooting and Training Center, Jeet Kune Do Unlimited, Meyer Martial Arts, and its owners and employees (collectively Academy), will involve sparring and physical contact with other individuals, which may result in personal injury. Other programs offered by the Academy, including stick fighting and street grappling, also present a risk of personal injury to the participant. By signing below I am acknowledging my intent to release, waive, and discharge the Academy from any claim or liability for injury to my person or my child/children hereafter occurring at or around the Academy from any cause, whether or not such injury results from the active or passive negligence of the Academy. Accordingly, I, myself, and children, and for my and their successors, personal representatives, and assigns, hereby (I) release and waive any claims and causes of action against the Academy for personal injury, loss and /or consequential damage to me or my children resulting from the future passive or active negligence of the Academy in the operation, management, or supervision of the Academy and (I) agree to indemnify, defend, and hold the Academy free and harmless from any cost, loss, or liability arising out of any injury to myself or my children in or around the Academy proximity resulting from the negligence of the Academy. I further understand that I am not required to do any drill or exercise and can stop any drill at any time. I take responsibility for any training that I undertake.
Acknowledge

Photo Release

We often use pictures and videos of class on social media, below is your acknowledgement and permission to use pictures that may include you on our various social media and marketing material. If you do not agree to this, please acknowledge your responsibility as follows.

In Consideration of the following, receipt whereof is acknowledged as provided herein, I hereby agree as follows:
I hereby agree to appear in printed and online images, I give and grant to Premier Shooting and Training Center(Company) it's and their respective licensees, successors and assigns (herein collectively call the "licensed parties"), the right to exhibit such photography and content and promote the Product as follows:
- Terms of Use: Printed and online materials
- Scope of Use: Unlimited
- Compensation: Zero
I agree that all photography of me used and taken by the licensed parties is owned by them and that they may copyright material containing same. If I should receive any print, negative or other copy thereof, I shall not authorize its use by anyone else. I warrant and represent that this license does not in any way conflict with any existing commitment on my part. I have not heretofore authorized (which authority is still in effect), nor will I authorize or permit for the term hereunder, the use of my name, picture, portrait, likeness, actions or testimonial statement in connection with the promotion of any product or service competitive to or incompatible with The Product.
Nothing herein will constitute any obligation on the licensed parties to make any use of the rights set forth herein.
I agree

If you disagree to the use of your picture please acknowledge the following:
I acknowledge that it is my responsibility to keep myself or my child out of pictures and videos and to remind the staff of my preference.
Acknowledge

Are you 18 years or older?
I hereby certify that I am 18 years or olderI am signing as the Parent or Guardian of a student under the age of 18

Print name (of responsible party)

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