Participant / Student Information

First Name *

Last Name *

Age: *

Select your program: *

Street Address *

Address Line 2

City *

State *

Zip Code *

Emergency Contact Name: *

Emergency Phone: *

Email Address (primary): *

Secondary email- not required:

(email will not be shared - only used to communicate info related to classes)

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Please provide any other information that you think is important to your needs.

WAIVER OF LIABILITY

In consideration of the agreement of Body Bionics to accept the Student as listed in the registration (hereinafter "Student"), it is hereby expressly agreed between the Student and Body Bionics as follows:

WHEREAS, the Student desires to enter into the study of martial arts training, and Body Bionics is engaged in the teaching of same;

WHEREAS, the Student has made application to Body Bionics for acceptance as a practitioner of martial arts training, or the Student wishes to continue the Student’s martial arts training with Body Bionics;

WHEREAS, the Student fully understands that martial arts training involving the study and practice of martial arts, which of necessity, may involve rigorous physical exertion and bodily contact;

THEREFORE, it is hereby agreed, with such agreement being an integral part of the consideration passing from the Student to Body Bionics that the Student hereby fully and without reservation agrees to forever release Body Bionics from liability for any and all claims for injuries, damages, or losses resulting or arising from the association of or between Body Bionics and the undersigned Student by direct or indirect result of the Student attending or participating in the training exercises or any activities of Body Bionics related in the broadest possible sense to the activities of Body Bionics. Further, Student agrees to indemnify and hold harmless Body Bionics from any and all claims, including, without limitation, negligence claims, owned by Student, derivative of Student or transferred or assigned by Student, said indemnification to include the amounts of the claims and Body Bionics' cost of defending the claims, including attorneys' fees. Both parties hereto understand and agree that this covenant shall survive the signatories hereto to further act to bind the heirs, successors, assigns, executors, or any other representative or interested party of the Student in any manner in which the Student him/herself would be bound, and that the benefits flowing herefrom shall inure to Body Bionics, without limitation to its present or future owners, employees, representatives, students, teachers and all other individuals and/or business entities of any type who may in any way be associated with Body Bionics. Further, the Student understands that this agreement modifies in writing any previous agreement written or oral to which the parties have entered and that this agreement supersedes and replaces any previous agreement written or oral. Further, the Student or Guardian, by his/her signature, certifies that he/she read and fully understands the terms of this Release and Waiver of Liability.

I have read the RELEASE AND WAIVER OF LIABILITY.

IMAGES

I understand that Body Bionics frequently captures images of its sessions and Students via photo and/or video. I am aware that these images may contain photos and/or videos of the Students registered in the program. I further understand that Body Bionics owns these images and the right to use them for marketing purposes including but not limited to website postings and printed materials.

By registering, I acknowledge that I have read, understand and agree with the above statements and conditions and agree to abide by them.