PHADY’S MUAY THAI INC.
82 Beverly St. Cambridge, ON N1R 3Z7
coachphady@hotmail.com
519-584-5426 / 5192216662
www.phadymuaythai.ca
Waiver / Physical Accident Release of Liability
I understand that participating/competing in amateur Muay Thai involves progressive physical exercise and may involve extreme physical exertion. I waive any possibility of personal injuries, which may be blamed upon such a program in the future or present, and accept responsibility for requesting such exercise and competition. I acknowledge that the possibility of certain unusual physical injuries in this martial arts program does exist. I confirm that I have consulted with my physician and that I am physically fit to participate in martial arts programs. They include, but are not limited to ABNORMAL BLOOD PRESSURE, FAINTING, DISORDERS OF THE HEART, HEARTBEATS, SPRAINED LIGAMENTS, STRAINED MUSCLES AND, IN RARE INSTANCES BOME FRACTURES OR HEART ATTACK. Due to the nature of martial arts programs, I understand that there may be physical contact and I may receive possible PUNCHES ON THE HEAD AND UPPER TORSO (chest, stomach, ribs etc). Although these PUNCHES TO THE HEAD MAY LEAD TO INJURIES SUCH AS FRACTURED TEETH, and or FRACTURES OF THE BONE STRUCTURE OF THE FACIAL AREA.
I fully understand that KICKS and KNEE strikes are possible to the LEGS and UPPER TORSO (chest, stomach, ribs) and HEAD area with possible BRUISING CUTS and BONE FRACTURES resulting. I also realize that ELBOW strikes to the HEAD and BODY are possible, and may result in BRUISING, CUTS and BONE FRACTURES. PHADY’S MUAY THAI INC, shall not be liable for any damages arising from personal injuries or damage which may occur to a member in, on or about the premises of any schools affiliated with PHADY’S MUAY THAI INC. or any halls, gyms etc. that may be rented, leased, owned or borrowed for or by PHADY’S MUAY THAI INC, and he/she does hereby and forever release PHADY’S MUAY THAI INC, its directors, officers, council, advisors, members, owners, employees, other persons participating and associated with PHADY’S MUAY THAI INC whether the same be known or unknown, anticipated or unanticipated resulting from or arising out of the Member’s unintended use of the said club and the facilities there of, including, but without limitation any claims for personal injuries resulting out of the negligence of PHADY’S MUAY THAI INC, or its owners, employees and any people associated with PHADY’S MUAY THAI INC, or on said premises including other persons using the said premises as guest members.
I understand that I would have to follow all the rules. Failure to do so can lead to my expulsion and membership cancellation and inability to participate in a PHADY’S MUAY THAI INC event. I hereby release and discharge PHADY’S MUAY THAI INC, and all of its affiliates and governing bodies, clubs, coaches, officials, members, agents, officers and employees from all claims, demands, actions, judgments and executions which the undersigned’s heir, executors, administrators, or assigns may have, or claim to have, for all personal injuries, known or unknown, and injuries to property, real or personal, caused by, or arising out of, the participation in the sports activity of Amateur Muay Thai. I the undersigned fully understand that this sport activity has inherent risks involved, and I am fully aware of the nature of these risks, but waive rights, claims, cause of action etc. as heretofore enumerated, and do hereby assume the risk in full. I the undersigned, have read this Release/Waiver and understand all its terms and conditions, I execute it voluntarily and with full knowledge of its significances.
Photo/Video Release
I hereby grant the Phady's MT permission to use my likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web- based publications, without payment or other consideration.
I understand and agree that all photos will become the property of the Phady's MT and will not be returned.
I hereby irrevocably authorize the Phady's MT to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo.
I hereby hold harmless, release, and forever discharge the Phady's MT from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.
I HAVE READ AND UNDERSTAND THE ABOVE PHOTO RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENTS/GUARDIANS AS EVIDENCED BY THEIR SIGNATURES BELOW. I ACCEPT: