Fite108 Waiver and Release Form
Client Enrolment and Liability Waiver Agreement
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$49 for two weeks training and FREE gloves
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49.00
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Name
First Name
Last Name
Date of Birth
-
Day
-
Month
Year
Date
Email Address
example@example.com
Address
Street Address
Street Address Line 2
Suburb
State
Postcode
Contact Number
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
Why have you chosen to do Muay Thai?
How did you hear about us?
Facebook
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Friend/Family
Other
Do you have any injuries or take any medications that we should know about?
If injuries/medications are stated, do you have doctors clearance to exercise?
Awareness
Instruction will be limited to that of fitness training and Muay Thai boxing techniques. There are risks involved with participation and they are the sole responsibility of the participant. I have informed myself and understand and accept any associated risks regarding these activities at any time within these facilities, including the risk of personal injury. I am not aware of any medical condition that would preclude me for participating in any activity within these premises. If I have any concerns regarding health issues, I will ensure that the gym and trainers will be made aware of these concerns prior to participation. I have the right to withdraw or refuse participation from any activity at any time as do the gym and its trainers reserve the right to limit or refuse the participation of any student or any activity as they deem warranted.
Release and Waiver
Release and Waiver I consent to the use by Fite108 gym of pictures and videos in full or in part, in any form, with or without other material, throughout the world, without limitation, for, promotional material, internet, television, radio, theatrical medium, or any other medium by any devices now known or hereafter devised and I do hereby Waive any compensation in regard thereof as well as any future rights to the aforementioned. I hereby release and discharge Fite108 gym and its staff of any responsibility and liability for personal injury, including loss of life or loss or damage of personal property, while participating in any activity associated with the gym and its staff, on or off the premises. This Release and Waiver applies to all claims, foreseen or unforeseen, including negligence and breach of duty of care. This agreement is intended to be broad based and inclusive as permitted by law. I hereby acknowledge to have read and fully understand the contents of this agreement and recognize that it is a release of liability. You expressly agree to release and discharge the trainer or instructor from any and all claims or causes of action and you agree to voluntarily give up and waive any right that you may otherwise have to bring a legal action against the trainer or instructor for personal injury or property damage.
Fees and Cancellation
The above fees will be debited from your account on a fortnightly or monthly basis and include a 4 week shutdown period (2 weeks at Christmas and 2 weeks in July for a Thailand trip – all are welcome) and cannot be paused. If your payment is rejected for any reason there will be a $15 failed payment fee in addition to your fees. We have no cancellation fee but do need 30 days written notice and an appointment with Kru Tim Drury.
Charges
As part of our fee structure, our billing company, Educational Funding Company, debits our members each week, fortnight or month. Please Note the following charges: 1. Customer load fee – NIL 2. EFC billing fee - $2 per debit 3. If your debit is rejected, the failed payment fee is $15
Makeup Lessons
Makeup lessons are available for any missed lessons, fees cannot be suspended/paused
Signature
Date
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Day
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Year
Date
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