NOX Martial Arts Clubs Inc. Athlete Consent Form
To be completed by athlete or parent / legal guardian if athlete is under legal age.
Email *
Athlete First and Last Name *
Athlete's Birth date *
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Emergency Contact Name *
Emergency Contact Mobile Phone Number *
PARTICIPATION AGREEMENT/DISCLAIMER I declare that I intend to use some or all of the activities, programs, and services offered by NOX Martial Arts Clubs Inc. And I understand that each person, (myself included), has a different capacity for participating in such activities, facilities, programs, and services. I am aware that all activities, programs, and services offered are educational, recreational, and/or self-directed by nature. I assume full responsibility during and after my participation, for my choices to use or apply, at my own risk, any portion of the information or instruction I receive. I understand that part of the risk involved in taking any activity or program is relative to my own state of fitness or health (physical, mental, or emotional) and the awareness, care and skill with which I conduct myself in that activity or program. I acknowledge that my choice to participate in any activity, program, and service of NOX Martial Arts Clubs Inc. Brings with it the assumption by me of those risks or results stemming from this/these choice(s) and the fitness, health, awareness, care, and skill I possess and use. In addition, I understand that I am free to withdraw from, reduce, or modify my involvement in any program activity and realize that I should do so upon recognition of any transient lightheadedness, fainting, chest discomfort, leg cramps, nausea, etc. I further understand that activities, programs, and services offered by NOX Martial Arts Clubs Inc. are sometimes conducted by personnel who may not be registered, certified or licensed instructors or professionals. I accept the fact that the skills and competencies of some of the employees and/or volunteers will vary according to their training and experience and that no claim is made to offer assessment or treatment of any mental or physical disease or condition by those who are not duly registered, certified, or licensed and herein employed to provide such professional services. In, addition, I acknowledge that I have inquired about the nature of any activity, programs, and services offered, by NOX Martial Arts Clubs Inc., that I am completely familiar with, and have been informed of any inherent risks. I declare that I have read, understood and agree to the contents of this PARTICIPATION AGREEMENT and its TERMS and CONDITIONS in its entirety. *
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TERMS AND CONDITIONS LEGAL COSTS The Member/Parent/Guardian agrees to pay NOX Martial Arts Clubs Inc. all cost and expenses incurred by NOX Martial Arts Clubs Inc. in enforcing any provisions of this agreement, on a solicitor and his own client basis.VALUABLES NOX Martial Arts Clubs Inc. is not responsible for the loss or theft of or damage to personal property. Do not bring valuable or personal equipment to any NOX Martial Arts Clubs Inc. location. Members are required to lock up valuables and personal property. Locks left on lockers overnight will be removed from lockers at the members' expense. NOX Martial Arts Clubs Inc. will not be responsible for the contents of these articles left in the lockers.RULES AND REGULATIONS All rules, regulations and privileges of membership. including but not restricted to membership dues, facilities, services and hours of operation are subject to change at any time without notice in the sole and absolute direction of NOX Martial Arts Clubs Inc. and it's directors. Any such changes do not in any way affect the provisions of the Contract or release the Member/Parent/Guardian from any obligation hereunder. (Subject to Reasonable Changes Without Advance Notice).CANCELLATION OF MEMBERSHIP a) Noncompliance with Rules and Regulations. In the event of noncompliance by the Member/Parent/Guardian with the rules, regulations or privileges of membership, NOX Martial Arts Clubs Inc. shall have the right to take whatever action it deems necessary, including cancellation of membership, in which case there shall be no obligation whatsoever to refund or return any portion of the tuition fee or payments paid or payable to the date of cancellation by the Member/Parent/Guardian. b) The Member/Parent/Guardian agrees while engaging in the use of any facilities of NOX Martial Arts Clubs Inc„ the members conduct will at all times be such that it presents no danger to other members or staff or interferes with the quiet enjoyment of other members or disrupts the staff in the carrying out of their duties. Evaluation of conduct will be by the management of NOX Martial Arts Clubs Inc. and such evaluation shall in all cases be final and conclusive. Failure by the member to comply shall permit NOX Martial Arts Clubs Inc. to revoke the membership without any obligation to refund any portion of the initiation fee or any dues paid by the member and shall constitute a default hereunder making any and all monies payable immediately under the membership term as set forth in this contract. c) In the event nonpayment of payments occurs, a member's right of membership shall be subject to suspension and/or collection agency at the sole and absolute discretion of NOX Martial Arts Clubs Inc. Such suspension or cancellation at any time shall not, however, affect in any way the obligations of the member to pay payments and for payments and other charges payable up to the date of cancellation or suspension.ADMINISTRATION -NOT REFUNDABLE The Member/Parent/Guardian acknowledges and agrees that NOX Martial Arts Clubs Inc. has earned the Administration/Insurance Fee and that notwithstanding any voluntary withdrawal or proper cancellation suspension of membership or the failure of the member to take advantage of the privileges of membership for any reason whatsoever, the Member/Parent/Guardian shall not be at any time entitled to a refund of all or any part of the Administration/Insurance fee already paid and shall remain liable for any part thereof nor yet paid at any time.WAIVER OF RIGHTS AND SEVERABILITY NOX Martial Arts Clubs Inc. reserves the sole and absolute discretion to waive any requirement of this Contract or obligation of any member whatsoever at any time and any such waiver shall not be deemed to be a waiver of any future accruing similar requirement or obligation unless it is expressed in writing to be a waiver of such matters. The failure of NOX Martial Arts Clubs Inc. to enforce any obligation or demand or collect any payment due under the Terms of the contract shall not be deemed a waiver of the right to enforce, demand or collect such obligation or payment at any time. Should any provision of this Contract be found to become unenforceable or void for any reason whatsoever at any time such occurrence shall have no effect whatsoever on the balance of this contract, and all provisions hereof or any portion of any provisions hereof or any such provisions are deemed to be severable in such manner.ACCIDENT AND INJURIES The Member/Parent/Guardian agrees to undertake sole responsibility in attending the facilities of NOX Martial Arts Clubs Inc. It is a condition of the use of the facilities (within or without the premises) for exercise or otherwise including but not limited to parking, by any person including all members and their guest(s), (children or adults) that such person or persons (or their guardians or the person bringing them into NOX Martial Arts Clubs Inc.) voluntarily assumes all risks of accident or damage to his\hur (or their) person or property and loss thereof. It is acknowledged that NOX Martial Arts Clubs Inc. does not provide patrolling in the parking lot(s), parking building(s), or any parking area a member may use while attending NOX Martial Arts Clubs Inc. classes or facilities or functions. The Member/Parent/Guardian assumes any risk for any guest (children or adults) they allow or cause to attend the facilities of NOX Martial Arts Clubs Inc. Neither NOX Martial Arts Clubs Inc., its officers, instructors, agents or employees or members shall be liable for any liability or demand of any kind whatsoever relating to the usage of the facilities associated with NOX Martial Arts Clubs Inc. Member/parent/Guardian agrees to hold NOX Martial Arts Clubs Inc., its officers. agents and employees harmless from any claim, liability or demand of any kind or on account of personal injury, property damage or loss of any kind, in whole or in part, upon the members claim that he or she had not agreed to assume the risks specified above. Member/Parent/Guardian undertakes the responsibility to inform users of the conditions of this membership agreement. NOX Martial Arts Clubs Inc. instructors or employees will be available whenever possible to familiarize the member or guest with NOX Martial Arts Clubs Inc. facilities. (Sports activity and physical exercise should be comfortable. Immediately stop any exercise activity if you feel faint, dizzy, nauseous, shortness of breath. or any pain. Any exercise or sporting activity can be hazardous to your health if you do not use common sense and as stated above, only you can monitor your personal physical feelings). NOX Martial Arts Clubs Inc. makes no warranties and no representatives express or implied, other than those set forth and the Member/Parent/Guardian acknowledges and agrees that the Member/Parent/Guardian has not relied on any warranties or representation other than those set forth in this agreement.CANCELLATIONS Regularly scheduled classes may be cancelled due to holidays, function, event, inclement weather, third party cancellation of facilities, or other as necessary. Cancellation shall not, however, affect in any way the obligations of the member to pay payments as previously committed to.COPYRIGHT All demonstrations, regular participation tournaments and all other activities are subject to royalty free recording. Pictures, videos, posters and all other media for promotion gathered by NOX Martial Arts Clubs Inc. shall not be subject to remuneration of any kind nor recognition in cases where deemed appropriate. Media submitted to NOX Martial Arts Clubs Inc. without written notice to be returned will become property of NOX Martial Arts Clubs Inc.LATE PICK-UPS After each scheduled class, instructors will be on-site for 15 minutes. The Parent/Guardian of minors agree to pick-up minor members in a timely manner. Parent/Guardian acknowledges that a fee of $20.00 can be charged at our discretion if instructors are made to remain and supervise minor members after class. Neither NOX Martial Arts Clubs Inc., nor its instructors, officers, agents nor employees shall be held liable for any liability or demand of any kind whatsoever relating to this service.TUITION AND EXAMINATION FEES I hereby apply to be admitted as a student to NOX Martial Arts Clubs Inc. and I agree to pay the tuition fee set out on this form. My failure to complete a course or to continue in a course does not relieve me of my obligation to pay the tuition fees as set forth on this form. I understand that I will be examined and supervised by trained personnel and on completion of the applicable examination I may receive official belt recognition and certification. The cost of any examination is not included in the tuition fee.ATTIRE and CLOTHING For hygienic and safety reasons, I agree to participate in any services offered by NOX Martial Arts Clubs Inc. wearing only clean and non-binding clothing, free of stains, dirt, and odor. Where shoes are permitted in class, only clean indoor shoes will be worn. Repeated warnings for non-compliance of this condition will, at our discretion, result in a cleaning fee of $20.00 be charged to your account for each infraction and possibly cancellation of your membership without any refunds. *
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Covid-19 WAIVER -- ASSUMPTION OF THE RISKS AND WAIVER OF LIABILITY RELATED TO CORONAVIRUS/COVID-19: The novel Coronavirus/ COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. NOX Martial Arts Clubs Inc. has put in place preventative measures to reduce the spread of COVID-19; however, NOX Martial Arts Clubs Inc. cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending NOX Martial Arts Clubs Inc. could increase your risk and your child(ren)’s risk of contracting COVID-19.By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that you may be exposed to or infected by COVID-19 by attending NOX Martial Arts Clubs Inc. and that such exposure or infection may result in personal injury,illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at NOX Martial Arts Clubs Inc. may result from the actions,omissions, or negligence of myself and others, including, but not limited to, NOX Martial Arts Clubs Inc.'s employees, volunteers, and program participants and their families.I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my myself (including, but not limited to, personal injury, disability, and death), illness,damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my attendance at NOX Martial Arts Clubs Inc. On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless NOX Martial Arts Clubs Inc.'s employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Club, its employees, agents, and representatives,whether a COVID-19 infection occurs before, during, or after participation in any program of NOX Martial Arts Clubs Inc. *
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Name of Legal Guardian. (If same as Athlete please write "Same".) *
A copy of your responses will be emailed to the address you provided.
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