HumaGenics LLC – Top Defense & Fitness (DBA)
990 South Main Street Suite E,
Logan, UT 84321
Phone: 435-799-8220
The undersigned individual (the Member or legal guardian), hereby indicates their desire to become a member of HumaGenics LLC – Top Defense & Fitness (DBA) or to be trained by the same, pursuant to the terms and conditions of this agreement.
INJURY WAIVER AND RELEASE OF LIABILITY FORM
In consideration of participating in health, weapons training, firearms training, weapons retention, fitness, boxing, or mixed martial arts activities, and for other good and valuable consideration, I hereby agree to release and discharge from liability arising from negligence HumaGenics LLC – Top Defense & Fitness (DBA) and its owners, directors, officers, employees, agents, volunteers, participants, and all other persons or entities acting for them, on behalf of myself and my children, parents, heirs, assigns, personal representative and estate, and also agree as follows:
- I UNDERSTAND that mixed martial arts is the systems of unarmed and armed fighting techniques including but not limited to: boxing, kickboxing, muay thai, wrestling, judo, and jiu-jitsu, weapons. Gym activities may also include general fitness, weight lifting, stretching, yoga, dance, and strength & conditioning.
- I UNDERSTAND that these martial arts techniques, formal exercises, conditioning exercises, and other physical activities will require me to engage in strenuous physical exercise and activity, either individually, in participation with other students, instructors at the facility, or with physical objects. These activities involve known and unanticipated risks which could result in physical or emotional injury, paralysis, or even death.
I CERTIFY (or the “Student”) that I am physically fit, have sufficiently prepared or trained for participation in the programs, activities or events offered by HumaGenics LLC – Top Defense & Fitness (DBA), and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in these programs, activities, or events onsite / offsite HumaGenics LLC – Top Defense & Fitness (DBA) premises.
I ACKNOWLEDGE that this Injury Waiver and Release of Liability Form will be used by HumaGenics LLC -Top Defense & Fitness (DBA), its program instructors, and their affiliates, and that it will govern my actions and responsibilities at said programs, activities, or events.
IN CONSIDERATION of my agreement with HumaGenics LLC – Top Defense & Fitness (DBA), and permitting me to participate in these programs, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows:
(A) I WAIVER, RELEASE AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from any HumaGenics LLC – Top Defense & Fitness (DBA) program, activity, or event, THE FOLLOWING ENTITIES OR PERSONS: HumaGenics LLC – Top Defense & Fitness (DBA), and/or its directors, officers, employees, volunteers, representatives, and agents, the program instructors, activity or event holders, activity or event sponsors, activity or event volunteers:
(B) I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this agreement from any and all liabilities or claims made as a result of participation in these programs, activities, or events, whether caused by the negligence of release or otherwise.
I ACKNOWLEDGE that HumaGenics LLC – Top Defense & Fitness (DBA) and its directors, officers, volunteers, representatives, and agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific program, activity, or event on behalf of HumaGenics LLC – Top Defense & Fitness (DBA).
I ACKNOWLEDGE that these programs, activities and events may involve a test of a person‘s physical and mental limits and may carry with it the potential for death and serious injury. The risks may include, but are not limited to, those caused by facilities, temperature, condition of participant, equipment, actions of other people including, but not limited to, participants, volunteers, spectators, coaches, event officials, and event monitors, and/or producers of events, and lack of hydration.
I UNDERSTAND that the types of injuries described in above paragraphs may result not only from intentional action, but also from inadvertent, negligent, or reckless action, by myself or others, including the malfunction or failure of any of the equipment or facilities (including but not limited to pads, cages, protectors, punching bags, plyometric boxes, ropes, straps, balls, blocks, kettlebells, weights, machines, and tumbling mats, etc) and errors or mistakes in instruction or performance of fighting or defense techniques by instructors or students in the facility.
I UNDERSTAND that the Releasees do not authorize me to use any of the mixed martial arts techniques that I learn in my studies against any other person, in any circumstances other than during martial arts training, exhibitions, or demonstrations in which my instructors, my physician, and I agree I am sufficiently qualified and physically able to participate in the facility or elsewhere.
I UNDERSTAND that it is my duty to consult my physician before beginning any exercise program or participating in any athletic activity including but not limited to mixed martial arts. If I have any disabilities or illnesses, am pregnant, or currently seeing a psychological therapist, I have advised Releasees of this fact, and will obtain written consent from my physician or therapist to participate in any activities in the facility. If at any time I believe that event conditions are unsafe or that I am unable to participate due to physical or medical conditions, then I will immediately discontinue participation.
I HERBY irrevocably release, consent and authorize HumaGenics LLC – Top Defense & Fitness (DBA) and its agents to use my photograph/video/likeness/voice, as it pertains to my participation or my child’s participation with HumaGenics LLC – Top Defense & Fitness (DBA), in any manner for promotional efforts without expectation of or right to any reimbursement in connection with its use.
I HAVE NOT requested nor received any warranties as to the effectiveness of any activity/technique.
I EXPRESSLY ACCEPT and assume ALL of the risks inherent in this activity or that might have been caused by the negligence of the Releasees. My participation in this activity is purely voluntary and I elect to participate despite the risks. I agree to abide by all facility rules.
IN THE EVENT of an injury, condition, or death that surpasses the capabilities of HumaGenics LLC – Top Defense & Fitness (DBA), its officers, agents, employees, organizers, representatives, and successors, I hereby give permission to obtain qualified emergency medical assistance to myself, my son/daughter and to not hold HumaGenics LLC – Top Defense & Fitness (DBA), its officers, agents, employees, organizers, representatives, and successors liable for such occurrence. I represent that I have adequate insurance to cover any injury/damage I may suffer or cause while participating in these activities, or else I agree to bear the costs of such injury/damage myself.
I HEREBY voluntarily release, forever discharge, and agree to indemnify and hold harmless Releasees from any and all claims, demands, or causes of action which are in any way connected with my participation in this activity, or my use of their equipment or facilities, arising from negligence. Should Releasees or anyone acting on their behalf be required to incur attorney’s fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs. In the event that I file a lawsuit, I agree to do solely in the state where Releasees’ facility is located, and I further agree that the substantive law of that state shall apply.
- Myself or my child has the following condition, and I fully understand it offers a greater risk than normal. I release and hold harmless HumaGenics LLC – Top Defense & Fitness (DBA), its officers, agents, employees, organizers, representatives, and successors from any legal or liability action that may result in injury. And furthermore, I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this agreement from any and all liabilities or claims made as a result of participation in these programs, activities, or events, whether caused by the negligence of release or otherwise.
- “Condition”
I AGREE that if any portion of this agreement is found to be void/unenforceable, the remaining portions shall remain in full force and effect.
I INTEND this Agreement, Assumption of Risks, and Waiver to be binding upon any and all of my parents, children, present and former spouses or life partners, heirs, assigns, friends, personal representatives, and estate in perpetuity.
I HEREBY ACKNOWLEDGE that I am fully required to provide my own medical coverage and that HumaGenics LLC – Top Defense & Fitness (DBA) will not be held liable for any expenses incurred for treatment of injuries while participating in these programs, activities, or events. The injury waiver and release of liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.
I CERTIFY THAT I HAVE READ THIS DOCUMENT, AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN OF MY OWN FREE WILL.
PARENT / GUARDIAN WAIVER FOR MINORS (Under 18 years of age) The undersigned parent and natural guardian does hereby represent that he/she is, in fact, acting such capacity, has consented to his/her child or ward‘s participation in the programs, activity or events, and has agreed individually and on behalf of the child or ward, to the terms of the injury waiver and release of liability set forth above. The undersigned parent or guardian further agrees to save and hold harmless and indemnify each and all of the parties referred to above from all liability, loss, cost, claim, or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act and release said parties on behalf of the minor and the parents or legal guardian. Print Name of Participant Age Signature of Participant Print Name of Parent/Guardian If Under the Age of 18, Parent/Guardian Must Sign Here