Idaho Women's Kickboxing
1867 S Canonero Way
Boise, Idaho 83709
Participant’s Name (please print) _______________________________________
Home Phone _______________ Cell Phone(s) ____________________________
Email Address (print clearly please)_____________________________________
Release of Liability
I _____________________________, understand that there are inherent risks associated with activities around a gym and, more specifically, with the program offerings of kickboxing, and that prior to beginning any program involving physical exertion, the participant (I/my child) should obtain medical clearance from a physician. I understand that medical emergencies, injuries and complications can occur as a result of strenuous physical activity associated with kickboxing. I voluntarily consent to attend or participate or have my child/children attend or participate in kickboxing activities. I further release the Cross family (who own the home and kickboxing facility), the kickboxing instructors, Pamela Cross, and all volunteer teachers from any claim that I or my child may have against them as a result of injury or illness incurred, while using the kickboxing facility at the Cross home. This release of liability shall include (without limitation) any claims of negligence or breach of warranty. This release of liability is also intended to cover all claims that I, my children, or my family or estate, heirs, representatives, or assigns may have against the Cross family, kickboxing instructors and volunteers. I knowingly and voluntarily waive any and all rights and causes of action, suits, damages and claims which I may have against the Cross family, Pamela Cross, and any other instructors, or volunteers, thereof, in connection with or from participation in such above-described activity.
By signing this form, I declare that:
· I declare that I have read, understood, and agree to the contents of this informed consent agreement in its entirety.
· I also expressly assume all risks of all children I am responsible for bringing to the Cross premises, whether such risks are known or unknown to me at this time.
Signature of Applicant or Date
Parent or Legal Guardian