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Regan Iron House Kickboxing Participation Waiver, Release, Assumption of Risk, and Medical Authorization

Member Name: {name}
Date of Birth: {dob}
Address: {address}
Phone: {phone}
Emergency Contact: {contact_name}
Emergency Contact Phone: {contact_phone}
Emergency Contact Relation: {contact_relation}

1. Acknowledgement of Risk

I, {name}, understand and acknowledge that participation in kickboxing, martial arts, fitness training, sparring, pad work, bag work, strength and conditioning, stretching, drills, classes, private training, open gym use, competitions, demonstrations, and any related activities involves inherent risks.

These risks may include, but are not limited to:

Bruises, cuts, scrapes, sprains, strains, fractures, dislocations, concussions, dental injuries, eye injuries, joint injuries, muscle injuries, back or neck injuries;
Contact with other participants, instructors, coaches, staff, equipment, bags, pads, mats, flooring, walls, or other objects;
Slips, trips, falls, overexertion, dehydration, dizziness, fainting, fatigue, heat-related illness, or aggravation of pre-existing conditions;
Serious injury, permanent disability, paralysis, or death;
Exposure to communicable illnesses or infections;
Loss, theft, or damage to personal property.

I understand that these risks may arise from my own actions or inactions, the actions or inactions of others, the condition of the premises, the use of equipment, the nature of physical training, or the inherent risks of martial arts and combat sports.

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2. Voluntary Participation

I confirm that I am voluntarily participating in activities at the gym. I understand that I am not required to participate in any activity that I believe is unsafe, uncomfortable, or beyond my ability.

I agree to immediately stop participating and notify an instructor, coach, or staff member if I feel pain, dizziness, shortness of breath, nausea, unusual fatigue, injury, or any other concerning symptom.

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3. Fitness to Participate

I confirm that, to the best of my knowledge, I am physically and medically able to participate in kickboxing, martial arts, and fitness activities.

I understand that the gym, its owners, instructors, coaches, employees, contractors, volunteers, and representatives are not medical professionals and are not responsible for determining whether I am medically fit to participate.

I agree that I am responsible for consulting a physician or qualified medical professional before participating if I have any medical condition, injury, disability, illness, or concern that may affect my ability to safely participate.

Please list any relevant medical conditions, injuries, allergies, medications, or limitations that the gym should be aware of:

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4. Assumption of Risk

I knowingly and freely accept and assume all risks associated with my participation, including both known and unknown risks, whether arising from the inherent nature of kickboxing, martial arts, fitness training, use of equipment, actions of other participants, or other circumstances.

I understand that no activity can be made completely risk-free.

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5. Release and Waiver of Claims

To the fullest extent permitted by applicable law, I agree to release, waive, and discharge the gym, its owners, directors, officers, employees, instructors, coaches, contractors, volunteers, agents, representatives, landlords, affiliates, successors, and assigns from any and all claims, demands, actions, damages, losses, costs, expenses, or liability arising out of or related to my participation in gym activities, use of the premises, use of equipment, or attendance at the facility.

This release includes, but is not limited to, claims relating to personal injury, illness, death, property damage, or loss of personal property, except where such release is not permitted by applicable law.

I understand that I may be giving up legal rights by signing this document.

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6. Negligence Acknowledgement

I understand that some jurisdictions require a waiver to specifically refer to negligence in order to be effective.

To the fullest extent permitted by applicable law, I agree that this waiver and release applies to claims arising from the ordinary negligence of the gym or its owners, instructors, coaches, staff, contractors, volunteers, agents, or representatives.

This waiver does not apply where prohibited by law, including where liability cannot legally be excluded or limited.

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7. Indemnity Agreement

To the fullest extent permitted by applicable law, I agree to indemnify and hold harmless the gym, its owners, directors, officers, employees, instructors, coaches, contractors, volunteers, agents, representatives, landlords, affiliates, successors, and assigns from any claims, demands, damages, costs, expenses, or liability arising from:

My participation in gym activities;
My use of the premises or equipment;
My failure to follow instructions, rules, or safety requirements;
My negligent, reckless, or intentional conduct;
Any claim brought by another person as a result of my actions.

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8. Rules, Instructions, and Safety Requirements

I agree to follow all gym rules, instructor directions, safety instructions, posted notices, and equipment-use guidelines.

I understand and agree that:

I will not participate while under the influence of alcohol, cannabis, illegal drugs, or any substance that may impair my ability to train safely;
I will use appropriate protective equipment when required or recommended;
I will not spar, engage in contact drills, or increase intensity without permission from an instructor or coach;
I will treat other members, guests, instructors, staff, and coaches with respect;
I will immediately report unsafe conditions, injuries, or concerns to gym staff.

The gym reserves the right to refuse, suspend, or terminate participation if staff believe that my conduct, condition, or participation creates a safety risk to myself or others.

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9. Contact, Sparring, and Combat Sport Activities

I understand that kickboxing and martial arts may involve physical contact. This may include partner drills, controlled contact, defensive drills, clinch work, body contact, sparring, or other combat-sport activities.

I understand that sparring and contact activities carry increased risk, including concussion, facial injury, dental injury, eye injury, joint injury, and other serious injuries.

I agree that I will only participate in sparring or contact activities if I have permission from an instructor or coach and if I am wearing required protective equipment.

Optional: I consent to participate in controlled contact drills and/or sparring when approved by an instructor or coach.

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10. Medical Treatment Authorization

In the event of injury, illness, accident, or emergency, I authorize gym staff, instructors, coaches, or representatives to seek emergency medical assistance on my behalf if they believe it is necessary or appropriate.

I understand that I am responsible for any medical costs, ambulance fees, treatment costs, or related expenses arising from my participation, unless otherwise required by applicable law.

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11. Personal Property

I understand that I am responsible for my personal belongings while at the gym. The gym is not responsible for lost, stolen, or damaged personal property, including clothing, phones, wallets, jewelry, training equipment, vehicles, or other belongings.

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12. Photo and Video Release

The gym may take photographs or videos during classes, training sessions, events, or promotional activities.

Optional: I consent to the gym using photos or videos of me for promotional, educational, social media, website, advertising, or internal purposes.

If you do not consent, please write “I do not consent” here:

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13. Parent or Guardian Consent for Minors

If the participant is under the age of majority, this waiver must be completed and signed by a parent or legal guardian.

I confirm that I am the parent or legal guardian of the minor participant named above. I consent to the minor’s participation in gym activities and agree to the terms of this waiver on behalf of myself and the minor participant, to the fullest extent permitted by applicable law.

Parent/Guardian Name:

Relationship to Minor:

Parent/Guardian Phone:

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14. Understanding and Agreement

I confirm that:

I have read this waiver carefully;
I understand its contents;
I understand that participation in kickboxing, martial arts, and fitness training involves risk;
I understand that I may be giving up legal rights;
I have had the opportunity to ask questions before signing;
I am signing this document voluntarily.

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15. Signature

Member / Parent / Guardian Name:
Date Signed: {sign_date}

By signing below, I agree to the terms of this Kickboxing / Martial Arts Participation Waiver, Release, Assumption of Risk, and Medical Authorization.

Signature Name:
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Optional Add-On: Required Health Declaration

You can add this if you want a more explicit health confirmation:

Health Declaration

I confirm that I do not currently have any condition that I know would make participation unsafe. I agree to notify the gym before participating if my health condition changes.

Please list any injuries, medical conditions, allergies, medications, or restrictions:

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