BATTLE ARTS ACADEMY

Battle Arts Academy Trial Form & Waiver of Liability & Assumption of Risk Agreement

4880 Tomken Rd, Mississauga, ON L4W 1J8

Phone: (289) 622-8853

Email: [email protected]

MEMBER INFORMATION

First Name (Member) *

Last Name (Member) *

Address

Address *

City *

Province *

Country

Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, The Democratic Republic of the
Cook Islands
Costa Rica
Cote D"Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and Mcdonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic Of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People"S Republic
Korea, Republic of
Kuwait
Kyrgyzstan
Land Islands
Lao People"S Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia, The Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
UK
Ukraine
United Arab Emirates
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
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Postal Code *

Cell Phone (If minor use parent/guardian) *

Email (If minor use parent/guardian) *

Date of birth (YYYY-MM-DD) (Member) *

Sex (Member) *

Sex

Male
Female
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Which class would you like to try?

Boxing
Amateur Wrestling
Professional Wrestling
Muay-Thai
Ni-Gi BJJ
Circuit Classes
Kids BJJ/Muay-Thai/Wrestling
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Have you trained at another gym before?

Yes
No
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PARENT / GUARDIAN INFO FOR MINORS (UNDER 18)

Parent / Guardian First Name

Parent / Guardian Last Name

PLEASE READ CAREFULLY BEFORE SIGNING. THIS DOCUMENT AFFECTS YOUR LEGAL RIGHTS.

I HAVE READ AND UNDERSTOOD THIS WAIVER OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT. I UNDERSTAND THAT BY SIGNING THIS DOCUMENT, I AM WAIVING CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE THE RELEASED PARTIES. I SIGN THIS AGREEMENT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Note: Participants under the age of 18 must have a parent or legal guardian sign this Agreement on their behalf.

Participant Signature

Clear

I, the undersigned, certify that I am the parent or legal guardian of the participant named above, and I have read and understood this Agreement. I consent to the participant's participation in the Activities and agree to be bound by all the terms and conditions of this Agreement.

Parent/Guardian Consent (For minors)

Clear

Communication Opt-in *

I agree to receive communications from Battle Arts regarding events, promotions, and updates. I understand that I can unsubscribe at any time.

Upload Your Picture (Member) *

Upload Your Picture

Copy of your Photo ID (If minor use parent/guardian) *

Any ONE of the following: Passport, Drivers License etc.

This Waiver of Liability and Assumption of Risk Agreement is intended to be as broad and inclusive as permitted by the laws of the Province of Ontario. Participants are encouraged to seek independent legal advice if they have any questions regarding the implications of signing this document.