Waiver to Participate

Please fill out the following form
in order to participate in our classes.

Student First Name

Student Last Name

Date of Birth required

Parent Name

Phone

Address

Emergency Contact Name

Phone

Do you have any pre-existing medical conditions?

Yes

If 'yes', please specify.

Do you have any previous injuries?

Yes

If 'yes', please specify.

Do you have any previous martial arts experience?

Yes

If 'yes', please specify.

Payment is due before participating in any class or session.

REFUND, WITHDRAWAL, TRANSFER POLICY: All tuition and registration fees are non-refundable.

CANCELLATION & MAKE-UP: No make-up or reductions in tuition for any missed lessons. Private lessons require a 24-hour advance notice to reschedule.

PARKING LOT SAFETY REGULATIONS: Eplex Sports Academy is not responsible for theft or damage to vehicles or contents.

ADVERTISING CONSENT: I hereby give my consent to Eplex Sports Academy and E-Plex Buena Park branch to use photographs of me or my child for commercial purposes.

SPECIFICATION: I understand that Eplex Sports Academy and E-Plex Buena Park branch are private institutions and are not under the jurisdiction of Community Care Licensing Department.

WAIVER OF LIABILITY: In consideration of being granted permission to utilize the programs, attend classes, observation of classes and access equipment, property, and facilities at Eplex Sports Academy, I, on behalf of myself, my son/daughter, personal representative, or assigns, hereby release, waive, discharge, and covenant not to sue Eplex Sports Academy, its directors, officers, employees, and independent contractors from any and all liability arising from claims, including those arising from the negligence of Eplex Sports Academy, related to personal injury, accidents, illnesses, (including death), and property loss. This release encompasses incidents arising from, but not limited to, participation in classes, activities, observations, and the use of facilities, premises, or equipment.

ASSUMPTION OF RISK: In recognition of the inherent risks associated with physical activity, risks that persist despite vigilant efforts to prevent injuries, it is imperative to acknowledge that Eplex Sports Academy offers facilities and conducts activities, including but not limited to weightlifting, martial arts classes, and various sporting activities. The spectrum of potential risks spans from minor injuries to severe consequences such as concussion, heart attack, and, in extreme cases, fatality. Participation in martial arts specifically is acknowledged as a hazardous undertaking carrying the potential for serious personal injury. As a participant, it is incumbent upon me, or on behalf of my child, to willingly accept and bear all risks associated with significant personal harm, encompassing permanent disability, loss of life, and damage to or loss of personal property. This acknowledgement extends to instances where negligence or fault may be attributed, either in whole or in part, to the Released Parties or otherwise. I am cognizant of, comprehend, and express my appreciation for the inherent risks inherent in the activities associated with martial arts classes and programs at Eplex Sports Academy. I hereby confirm that my involvement is voluntary, and I knowingly assume all such risks associated with these activities.

INDEMNIFICATION: I agree to indemnify and hold Eplex Sports Academy and its shareholders, directors, officers, employees, contractors, volunteers, or agents harmless from any and all claims, actions, suits, costs, expenses, damages, and liabilities, including attorney's fees, brought as a result of my son/daughter's participation/involvement in the programs and/or classes and to reimburse them for any such expenses incurred, whether these programs/classes/activities occur inside or outside of Eplex Sports Academy premises. In addition, I give my permission for Eplex Sports Academy to seek necessary medical aid for my son/daughter in case of an emergency. I agree to accept financial responibilities for any cost incurred of any injury or accident of the above student's name.

SEVERABILITY: The foregoing waiver, assumption of risks agreement, and indemnity agreement are designed to be broad and inclusive to the extent permitted by the law of the State of California. In the even that any portion thereof is deemed invalid, it is mutually agreed that the remainder shall remain in full legal force and effect. I have thoroughly reviewed this waiver of liability, assumption of liability, and indemnity agreement and fully comprehend its implications. I acknowledge that by signing this agreement, I am relinquishing certain rights, including the right to pursue legal action. I am affixing my signature to this document of my own free will and voluntarily. It is my express intention, through this signature, to effect a complete release of all liabilities to the greatest extent allowed by law.

I agree to the terms above. (Sign Below)

Date