Thank You & Waiver Form
Our team is eager to have you join us! Please fill out the waiver below.
Participant Waiver & Release (Read Carefully Before Signing)
PLEASE READ THIS FORM CAREFULLY. Be aware that by signing this Participant Waiver & Release (the “Release”), you, ON BEHALF OF YOURSELF AND YOUR MINOR CHILD OR WARD, IF APPLICABLE, will be expressly waiving and releasing all claims that you may have against Total Impact Martial Arts And Fitness, LLC and Alpha Krav Maga International, Inc. and their affiliates, owners, directors, managers, officers, employees, agents, and all other persons or entities acting for the foregoing (collectively, “Total Impact”) related to injuries, damages, or losses that you and your minor child/ward may sustain while participating in any and all activities associated with Total Impact, and you will be assuming all risk and legal liability associated with such participation. Hereinafter, REFERENCES TO YOU SHALL BE DEEMED TO REFER TO YOU AND YOUR MINOR CHILD/WARD AS APPLICABLE.
In consideration of being permitted to participate in the Total Impact programs and/or being permitted to enter for any purpose any portion of any Total Impact programs and/or facilities, I, the undersigned, agree as follows:
1. Acknowledgement and Assumption of Risk.
I acknowledge that the programs, events, lessons, classes, workshops, competitions, and other activities conducted by Total Impact (collectively, the “Activities”) involve known and unanticipated risks and can result in physical or emotional injury, paralysis, permanent disability, death, and/or property damage. I understand such risks can be severe and cannot be eliminated despite the use of safety equipment and procedures without jeopardizing the essential qualities of the Activities. I expressly accept and assume all such risks and understand that I am responsible for any injuries or property damage caused to or by me while participating in Activities. Participating in Activities is purely voluntary and I elect to do so despite the aforementioned risks. I understand that prior to participating in the Activities, I must inspect the facilities and equipment to be used and agree that if at any time I feel unsafe I will immediately take all precautions to avoid the unsafe area or condition, will discontinue participation in the Activities, and will notify Total Impact of the unsafe area or condition.
2. Medical Condition and Treatment.
I certify that I am physically fit and I have no adverse physical condition that would prevent or inhibit my participation in any Activity. I have informed Total Impact of any conditions I have that may affect my ability to participate in the Activities and understand and agree that in permitting me to participate in the Activities Total Impact has relied on my representation that I am in good health. If at any time I believe that I am unable to participate in the Activities due to physical or medical conditions, I will immediately discontinue participation and will notify Total Impact of such condition. In the event that emergency medical treatment of me appears to be necessary during any Activity, I consent to such treatment by any local responders or caregivers, if available.
3. Non-Sexual Intent.
Some of the PHYSICAL ACTIVITIES require close bodily contact that is not designed or intended to have a sexual nature, intent or context.
4. Assumption of Responsibility and Risk Re: Infection Disease
Members understand that in any activity involving a publicly accessible place and involving other people, there is a risk of exposure to bacteria, viruses, or other communicable diseases (including, without limitation, risks associated with COVID-19), toxins, parasites, or other adverse health factors. Members must exercise reasonable care to minimize exposing others and advise leaders, and members if they discover they were previously contagious. Members assume the risk of exposure when they enter, attend, and train. Click here to see what we are doing about COVID-19 safety.
5. Waiver and Release.
I HEREBY WAIVE, RELEASE, DISCHARGE, AND COVENANT NOT TO SUE TOTAL IMPACT FOR ANY AND ALL CLAIMS, DEMANDS, OR CAUSES OF ACTION THAT ARE IN ANY WAY CONNECTED TO THE ACTIVITIES (COLLECTIVELY, “CLAIMS”), INCLUDING CLAIMS FOR MY DEATH, DISABILITY, PERSONAL INJURY, PROPERTY DAMAGE, PROPERTY THEFT, OR ACTIONS OF ANY KIND WHICH MAY HEREINAFTER ACCRUE, NOTWITHSTANDING THE FACT THAT SUCH CLAIMS MAY BE THE RESULT OF TOTAL IMPACT’S NEGLIGENCE. IN NO EVENT SHALL TOTAL IMPACT’S LIABILITY TO ME WITH RESPECT TO ANY CLAIM THAT IS NOT THE RESULT OF TOTAL IMPACT’S GROSS NEGLIGENCE OR WILLFUL MISCONDUCT EXCEED THE TOTAL FEES PAID BY ME TO TOTAL IMPACT WITHIN THE THIRTY (30) DAYS PRIOR TO THE DATE SUCH CLAIM ARISES.
6. Indemnification by Students and/or Parents.
I INDEMNIFY AND HOLD HARMLESS TOTAL IMPACT FROM ANY AND ALL LIABILITIES AND EXPENSES (INCLUDING REASONABLE ATTORNEYS’ FEES) OR CLAIMS MADE BY THIRD PARTIES DUE TO MY ACTIONS OR INACTIONS DURING ANY ACTIVITIES. FURTHER, IF THE MINOR ON BEHALF OF WHOM I EXECUTE THIS RELEASE OR ANY OF MY FAMILY MEMBERS, RELATIVES, OR OTHER GUESTS MAKES A CLAIM AGAINST TOTAL IMPACT, THE UNDERSIGNED WILL INDEMNIFY AND HOLD HARMLESS TOTAL IMPACT FROM ANY AND ALL LIABILITIES AND EXPENSES (INCLUDING REASONABLE ATTORNEYS’ FEES) RELATED TO SUCH CLAIM. SHOULD TOTAL IMPACT INCUR ATTORNEYS’ FEES AND COSTS TO ENFORCE THIS RELEASE, I SHALL REIMBURSE TO TOTAL IMPACT ALL SUCH FEES AND COSTS.
I agree not to bring any claim or suit against the school, Instructors, staff, guests, Members, landlord, or any other parties on behalf of my child for any injury or harm sustained by any event short of a criminal act, and then only the criminal shall be the subject of such a claim.
I shall indemnify the school, Instructors, staff, guests, Members, and any and all additional defendants covered by this agreement for all judgments, costs, attorney fees and other expenses incurred as a result of any suit brought by or on behalf of my child or ward.
7. Use of Media.
I hereby expressly grant Total Impact the right to copyright and/or use, reuse, or broadcast and republish videotapes, films, photographs, digital images, audio recordings, and testimonials (collectively, “Media”) of me or my property, and to put such Media to any use, without limitation or reservation, without compensation, and without my future review or approval of such use. I further relinquish all claims to the use or ownership of such Media. I also Acknowledge that I have no right to use any Total Impact’s curriculum, logo, name, documents, worksheets, or Media without Total Impact’s permission.
In the event that any provision of this Release shall be determined to be invalid, illegal, or unenforceable to any extent, the remainder shall not be impaired or otherwise affected and shall continue to be valid and enforceable to the fullest extent permitted by law.
This Release shall be governed by the laws of the State of Illinois. I agree to litigate any disputes related to this Release in Cook County, Illinois.
I HAVE HAD SUFFICIENT TIME TO READ THIS ENTIRE RELEASE AND, AT MY OPTION, CONSULT WITH LEGAL COUNSEL PRIOR TO SIGNING IT. I HAVE READ AND FULLY UNDERSTOOD THIS RELEASE AND AGREE TO BE BOUND BY ITS TERMS. I HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY UNDUE INFLUENCE OR INDUCEMENT, AND INTEND MY SIGNATURE TO BE COMPLETE AND UNCONDITIONAL RELEASE OF TOTAL IMPACT’S LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.