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Waiver/Liabillity Form
I have enrolled in the personalized health and fitness program offered through Black Widow MMA. After having notified a physician of my intended activity, I have been advised that it is safe to participate in said activity. I recognize that the program may involve strenuous physical activity including, but not limited to, muscle strength and endurance training, cardiovascular conditioning and training, and other various fitness activities. I hereby affirm that I am in good physical condition and do not suffer from any known disability or condition which would prevent or limit my participation in this exercise program. I acknowledge that my enrollment and subsequent participation is purely voluntary and in no way mandated by Black Widow MMA.
Having such knowledge, I hereby acknowledge this release, any representatives, agents, and successors from liability for accidental injury or illness which I may incur as a result of participating in the said physical activity. I hereby assume all risks connected therewith and consent to participate in said programs. I hereby agree to disclose any physical limitations, disability, aiments, or impairments which may affect my ability to participate in said program. If at any time I feel the need to stop, have shortness of breath, or feel that any activity may be negatively affecting my health, I should stop said activity, and if the issue persists, seek medical attention.
**MINORS under the age of 18 years old interested in the FREE TRIAL PASS, PRIVATE LESSONS, OPEN MAT, and/or in purchasing a gym MEMBERSHIP MUST have their legal parent or legal guardian consent and sign on their behalf.
Also, by signing this form, without expectation of compensation or other remuneration, now or in the future, I hereby give my consent to Black Widow MMA, its affiliates and agents, to use my image and likeness and/or any interview statements from me in its publications, advertising or other media activities (including the Internet). This consent includes, but is not limited to:
(a) Permission to interview, film, photograph, tape, or otherwise make a video reproduction of me and/or record my voice;
(b) Permission to use my name; and
(c) Permission to use quotes from the interview(s) (or excerpts of such quotes), the film, photograph(s), tape(s) or reproduction(s) of me, and/or recording of my voice, in part or in whole, in its publications, in newspapers, magazines and other print media, on television, radio and electronic media (including the Internet), in theatrical media and/or in mailings for educational and awareness. If you have any questions or concerns, please let us know.
COVID-19 Related Information: I affirm that I am not displaying any symptoms of COVID-19. I will not be allowed to participate in the class if I have tested positive and continue to display symptoms or have been in contact with someone who tested positive for Covid.
**Upon entering the premises for scheduled classes, the Participant shall present their name and associated check-in code to the designated staff members to officially confirm their attendance and arrival.
PROVIDING THE HIGHEST QUALITY MARTIAL ARTS TRAINING IN A SAFE AND SUPPORTIVE ENVIRONMENT FOR THE WHOLE AUSTIN COMMUNITY SINCE 2018
Black Widow MMA.
2007 Kramer Lane Suite 101 Austin, TX 78758
512-665-0468