## MYRIAD MIXED MARTIAL ARTS ACADEMY  

2100 E 13th St, Ames, Iowa 50010  

**WAIVER, RELEASE OF LIABILITY, AND ATHLETE AGREEMENT**

I, _____Thomas_{name}___Fulton___ (print name), am about to participate in martial arts training, exercises, and events offered by Myriad Mixed Martial Arts Academy ("the Academy"). I understand and acknowledge the following:

### **Acknowledgment and Assumption of Risks**

- I am participating entirely upon my own initiative and responsibility.  

- I will engage in activities including, but not limited to: Jiu Jitsu, Wrestling, Kickboxing, Muay Thai, sparring, grappling, and striking techniques.  

- I understand these activities involve inherent risks, including but not limited to:  

  • Sprains, strains, and soft tissue injuries  

  • Fractures and bone injuries  

  • Concussions and other head injuries  

  • In extreme cases, permanent disability or death  

- I fully understand and appreciate the nature of these risks.

- I hereby voluntarily and expressly assume all risks associated with my participation in activities at the Academy, including but not limited to those listed above.

### **Physical Fitness Declaration**

- I have consulted with a physician regarding my participation in these activities.  

- I represent and warrant that I am physically fit and have no medical conditions that would prevent my full participation.  

- I agree to immediately inform the instructors of any change in my medical condition.  

### **Liability Release and Indemnification**

I, for myself, my heirs, executors, and administrators, hereby:  

1. Release and hold harmless the Academy, its members, instructors (including Jake Bower, Luis Guillen, Kyven Gadson, Haris Variz, and any guest instructors) from any and all liability, claims, demands, actions, or causes of action arising from my participation.  

2. Agree to indemnify and defend the Academy against any claims arising from my participation.  

### **Responsible Use of Skills**

- I agree that the skills learned at Myriad Mixed Martial Arts Academy are to be used only for:  

  • Competition purposes within sanctioned events; or  

  • Self-defense purposes in life-threatening situations.  

- I will not use the techniques or skills learned at Myriad in a reckless or negligent manner that could harm others.  

- I understand that if the Academy becomes aware of any conduct by me that is detrimental to others or reflects poorly on the Academy (including reckless use of skills), Myriad reserves the right to deny services and terminate my membership immediately without refund.  

### **Supervision of Minors**

- Minors under the age of 16 must be accompanied by their parent or legal guardian while at Myriad Mixed Martial Arts Academy.  

- It is the responsibility of the parent or guardian to supervise their child at all times and ensure their safety while on Academy premises.  

- The Academy is not responsible for supervising minors outside of scheduled classes or training sessions.  

### **Athlete Agreement**

1. **Approval Requirement:**  

   - I understand that I must obtain written approval from Myriad MMA Academy coaches before participating in any competitions or fights representing the gym.

2. **Training and Conduct:**  

   - I agree to adhere to the training schedule and guidelines set by Myriad MMA Academy.  

   - I commit to maintaining professional conduct at all times, reflecting positively on the gym.

3. **Image and Likeness:**  

   - I grant Myriad MMA Academy permission to use my image and likeness for promotional purposes related to the gym.

4. **Medical Responsibility:**  

   - I acknowledge that participation in combat sports involves inherent risks of injury.  

   - I understand that Myriad MMA Academy does not provide insurance coverage for injuries sustained during training or competitions.  

   - I am solely responsible for obtaining and maintaining my own health and accident insurance coverage.

5. **Conduct and Termination:**  

   - I understand that any misconduct or actions that bring disrepute to the gym may result in disciplinary action, including termination of my association with Myriad MMA Academy.

6. **Dispute Resolution:**  

   - Any disputes arising from this agreement shall be resolved through mediation or arbitration as agreed upon by both parties.

7. **Severability:**  

   - If any portion of this waiver is held invalid, the remainder shall continue in full legal force and effect.

### **Weights and Equipment Use**

- I understand that the use of weights and equipment at Myriad Mixed Martial Arts Academy involves inherent risks of injury.

- I agree to use all weights and equipment properly and in accordance with their intended use.

- I will not attempt to use any weights or equipment without proper instruction or beyond my physical capabilities.

- I acknowledge that it is my responsibility to ask for assistance or guidance if I am unsure about the proper use of any weights or equipment.

- I understand that the Academy is not responsible for any injuries resulting from improper use of weights or equipment.

- I agree to report any damaged or malfunctioning equipment to the Academy staff immediately.

- I will follow all posted safety guidelines and instructions regarding the use of weights and equipment.

- I acknowledge that the Academy is not responsible for any injuries or damages resulting from the failure or malfunction of any equipment, even if such equipment is properly maintained and used as intended.

### **Additional Terms**

- I agree to follow all Academy rules and instructor directions at all times.  

- This waiver shall be governed by and construed in accordance with the laws of Iowa.

- This agreement is binding upon myself, my heirs, executors, administrators, successors, and assigns. I understand that by signing this agreement, I am waiving certain legal rights that I or my heirs, next of kin, executors, administrators, and assigns may have against the Academy.

### **Participant Information**

Name: ____Thomas____{name}_____Fulton____ Phone: ___630-221-1110________{phone}_________  

Emergency Contact: _____{Jen}_________ Phone: _____{6308186010}____  

Medical Conditions/Allergies: ______________{none}_____________________________  

I confirm that I am at least 18 years of age. If I am under 18, a parent or guardian has signed on my behalf.

**By signing below, I acknowledge that I have read, understood, and agree to all terms and conditions in this waiver.**

### **Signatures**

Participant Signature: ___________ Date: _______{sign_date}_________  

Parent/Guardian Signature (if under 18): ___________ Date: ____{sign_date}___  

**PLEASE COMPLETE THIS FORM BEFORE YOUR FIRST CLASS**  

**DO NOT ENTER THE MATTED AREA WITHOUT SUBMITTING THIS FORM**