Open Sparring Waiver Participation Form

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Given name(s) *

Surname *

Gender *

Male

Female

Other:

Date of Birth *

YYYY

Street Address *

City *

Postcode *

Phone Number *

How did you hear about Open Sparring?

Word of Mouth

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Other:

Emergency Contact Details

Name *

Phone Number *

I declare that I agree to the following:

I understand that sparring and training in martial arts involves dangers and risks that may cause various injuries and that these injuries may result in death or serious disability. I am participating at my own risk

I understand that sparring activities at Open Sparring may include, but will not be limited to, activities such as kicking, punching, hitting, stretching, twisting, jabbing, lunging, rolling, falling, jumping, hand locks, submissions, grappling and the use of various martial arts and fitness and self defence equipment. I realise that these activities, as well as all other martial arts activities, can be dangerous, but I am voluntarily choosing to participate in some or all of these activities and agree to assume the risk associated with my participation therein

I have not at any time suffered from any blackout, seizure, convulsion, fainting or dizzy spells, and am not presently receiving treatment for any illness, disorder or injury which would render it unsafe for me to take part in martial arts. I have advised Open Sparring of any health problems, physical impairments, injuries or medical conditions that may affect me

I hereby release Open Sparring, its owners, and the owner of the premises and all employees, staff and assistants, or any other persons involved in my participation in training at Open Sparring from any suit, demand, action or claim for compensation whether for personal injury or damage to property arising from my participation

I understand that I may be photographed or videotaped and consent for Open Sparring to use recorded media for advertising, publicity, commercial or other business purposes. I hereby release the providers from all claims of every kind on account of such use

Name of Parent/Guardian

Relationship to Student

Parent/Guardian Signature *

Please provide your initials. You agree that this is in effect your electronic signature.

Today's Date *

YYYY

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