registration and waiver of liability - adult Please enable JavaScript in your browser to complete this form.Name *FirstLastGenderMaleFemaleNon-BinaryPrefer Not to SayDate of BirthEmail *EmailConfirm EmailPhone Number *Type of Membership *Fitness (1 class/week) - $50 per monthContender (2 classes/week) - $100 per monthWarrior (3 classes/week) - $125 per monthChampion (Unlimited classes)- $160 per month *best dealDrop In - $20 per classMethod of Payment *I will pay cash at the gymI will pay with a credit/debit card at the gymPlease send me a link to pay onlineBoxing Experience *BeginnerSome Previous Boxing TrainingCompetitive Amateur BoxerPro BoxerCoach/TrainerRelevant Medical Issues (please check all that apply) *AsthmaAllergiesDiabetesConcussion historyHeart conditionNone to reportOtherEmergency Contact Name & Relationship to Member *Emergency Contact Phone *ATHLETIC ASSUMPTION OF RISK, WAIVER AND RELEASE OF LIABILITY. In consideration of being allowed to participate in any way in Al Amanecer Boxing Club athletic sports program, related events and activities, the undersigned acknowledges, appreciates, and agrees that: 1. The risks of injury and illness (ex: communicable diseases such as MRSA, influenza, and COVID-19) from the activities involved in this program are significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce these risks, the risks of serious injury and illness do exist; and, 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and, 3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and, 4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Al Amanecer Boxing Club their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL INJURY, ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. ACCEPTANCE OF ASSUMPTION OF RISK, WAIVER AND RELEASE OF LIABILITY *I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.Consent for Medical Treatment: As the participant in Al Amanecer Boxing Club, I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry in the event that I am unable to give consent at the time of incident. This care may be given under whatever conditions are necessary to preserve the life, limb, or well-being of the participant. *I consent to Emergency Medical Treatment.I do not consent to Emergency Medical Treatment.Photo Release Acknowledgement: I hereby authorize Al Amanecer Boxing Club to publish photographs taken of me, and my name, and likeness, for use in Al Amanecer Boxing Club’s print, online and video-based marketing materials, as well as other publications. I hereby release and hold harmless Al Amanecer Boxing Club from any reasonable expectation of privacy or confidentiality for myself associated with the images specified above. I further acknowledge that participation is voluntary and that I will not receive financial compensation of any type associated with the taking or publication of these photographs or participation in Al Amanecer Boxing Club’s marketing materials or other publications. I acknowledge and agree that publication of said photos confers no rights of ownership or royalties whatsoever. I hereby release Al Amanecer Boxing Club, its contractors, its employees, and any third parties involved in the creation or publication of marketing materials, from liability for any claims by me or any third party in connection with my participation. *I consent to the Photo Release.I DO NOT CONSENT to the Photo Release.I understand that I have 5 (Five) days from the date of entering this membership contract in which to cancel. Al Amanecer Boxing Club agrees to refund any fees paid if canceled within the aforementioned 5 days, less fair compensation for any services provided (up to a maximum of $100). *I HAVE READ AND UNDERSTOOD THE ABOVE AGREEMENT.Member's Name *Today's Date *Submit
