Signup

Liability Waiver Form

To the best of my knowledge, I am in good physical condition and fully able to participate in this course. I am fully aware of the risks and hazards connected with the participation in Muay Thai Kickboxing, or Boxing, including physical injury or even death, and herby elect to voluntarily participate in said event, knowing that the associated physical activity may be hazardous to me and my property.

I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OR LOSS, PROPERTY DAMAGE, OR PERSONAL INJURY, INCLUDING DEATH, that may be sustained by me, or loss or damage to property owned by me, as a result of participation in this course. I further certify that I am at least 18 years of age. If under 18, my parent/guardian is the below signed. I hereby RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE, Heavy Hands, Inc, Jordan LaFavor, Andrea LaFavor, their officers, servants, agents, and employees (hereinafter referred to as RELEASEES) from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me, or to any property belonging to me, while participating in physical activity, or while on or upon the premises where the event is being conducted. It is my expressed intent that this release and hold harmless agreement shall bind the members of my family and spouse, if I am alive, and my heirs, assigns and personal representative, if I am deceased, and shall be deemed as a RELEASE, WAIVE, DISCHARGE, and CONVENTION TO SUE the above named RELEASEES. I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be constructed in accordance with the laws of the State of Florida.

In signing this release, I acknowledge and represent that I HAVE READ THE FOREGOING Waiver of Liability and Hold Harmless Agreement, UNDERSTAND IT AND SIGN IT VOLUNTARILY as my own free act and deed; no oral representations, statements or inducements, apart from the foregoing written agreements have been made; and I EXECUTE THIS RELEASE FOR FULL, ADEQUATE AND COMPLETE CONSIDERATION FULLY INTENDING TO BE BOUND BY SAME.

Student Name: {name}, {sign_date}

Is Student a minor?    Yes     No

If yes, Parent must sign this waiver.

I hereby give consent to ______________________________________ (the “organization”) to
photograph, videotape, or otherwise digitally record and use images and/or sound recordings of
myself or my child or children (if applicable) to use in any public media, including radio, television,
internet, social media, print or in any of the organization’s or its partners’ publications,
productions, or posts. I understand that the intended use of such images and information is solely
for the purpose of advertising, marketing, fundraising and/or the promotional and public awareness
purposes for the organization. I hereby waive any rights or interest in the images or recordings, as
contemplated in this release.
I acknowledge that this consent to use images and/or recordings is being made solely for the
benefit of the organization and comes without any expectation of monetary compensation or other
benefit to me. To the extent that any benefit accrues or might accrue to the organization from the
use of images or information, I hereby and forever waive any interest in or claim to such benefits.
I hereby release and forever discharge the organization (including without limitation all corporate
affiliates and officers, directors, trustees, donors, employees, agents and volunteers) from any and
all claims, liability, actions, suits, demands, costs, expenses or indebtedness arising out of, related
to, or in any way connected with the use of images and materials described herein, and I hereby
waive all rights and interest in and to such information and materials.
I further acknowledge that there is no guarantee that any or all of the participants’ images or
recordings will be used in any released media.