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Liability Waiver and Informed Consent

WARNING, WAIVER, RELEASE OF LIABILITY, ASSUMPTION OF RISK
THIS AGREEMENT MUST BE SIGNED BY ALL PERSONS WHO WISH TO PARTICIPATE WITH ANY ELEMENTS MMA LLC CLASS, EVENT, PRIVATE SESSION OR ACTIVITY.

ADDITIONALLY, THIS AGREEMENT MUST BE SIGNED BY ALL PERSONS PARTICIPATING IN CLASSES, EVENTS, ACTIVITIES, AND PRIVATE SESSIONS WITH ARIAN DEIHIM (“Ari Heart”).

In consideration of being allowed to participate in any way in the classes, events, and/or activities of Elements MMA LLC or with Arian Deihim, I,

Participant's Name

First Name

Last Name

Date of Birth

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Parent/Guardian Name (of minor participant)

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

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Email

Do you or your child have any health concerns?

If yes, please explain below

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone

(###)

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In consideration of being allowed to participate in any way in the classes, events, and/or activities of Elements MMA LLC, I,

1. Recognize and understand that martial arts is an activity that involves physical contact and that my participation might result in serious injury, including permanent disability or even death, and severe social and economic loss. 2. Recognize and understand that strength, conditioning, yoga, and other physical fitness training are dangerous activities that my participation might result in serious injury, including permanent disability or even death, and severe social and economic loss. 3. Recognize and understand that such risks may be due to not only my own actions, but also the action, inaction or negligence of others, the regulations of participation, or the conditions of the premises, or of any of the equipment used. 4. Recognize that there may be other risks that are not known to me or to others or not reasonably foreseeable at this time. 5. Agree to inspect the facilities, equipment and pairings prior to participation in each training session. I will immediately inform an instructor if I believe that anything is unsafe or beyond my capability and refuse to participate. 6. Assume all of the foregoing risks and accept personal responsibility for any damages that may result from injury, permanent disability or death. 7. Enter training and/or competition through entirely of my own free will and understand the importance of following the rules of training and competition. 8. Certify that I am in good physical condition, and have no disease, injury or other condition that would impair my performance or physical and mental well-being during intense training practice and/or competition. 9. Grant permission in case of injury to have a doctor, nurse, athletic trainer, Elements MMA instructor or other emergency medical personnel provide me with medical assistance or treatment for such injury. 10. When participating in "Yoga Therapy" I understand that Arian Deihim and any other practitioners at Elements MMA, LLC are not licensed mental health practitioners, and that my participation in this activity involves physical, mental, emotional, and spiritual work that I assume all risk for, and release Arian Deihim and any other practitioners at Elements, MMA LLC from any liability related to this activity. 11. Release, waive, discharge and covenant not to sue, Elements MMA LLC, its affiliated organizations and governing bodies, their officers, instructors and personnel, other members of the organizations, participants, supervisors, coaches, sponsoring organizations or their agents, and if applicable, owners and lessors of the premises from any and all liability to the undersigned, his or her heirs and next of kin for any and all claims, demands, losses and damages which may be sustained and suffered on account of injury, including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the realeasees or otherwise.

I HAVE READ THE ABOVE HOLD HARMLESS, WAIVER, RELEASE, AND ASSUMPTION OF RISK. I FULLY UNDERSTAND ITS CONTENTS, AND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT. I HEREBY SIGN VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY.

Photo Consent

I hereby give Elements MMA permission to upload photos or videos of me or my child for marketing and sharing purposes on websites or social media. This is will be public. I understand that these photos and videos will be done in a reasonable and tasteful manner and are not used for any other purpose except for the above-stated purpose.

Yes

Online Signature

By signing this waiver, I hereby affirm that I have read and fully understand the above statements. I agree to the above terms and conditions.

By checking here, I am consenting to the use of my electronic signature in lieu of an original signature on paper.

Digital Signature

First Name

Last Name

Date

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