Digital Waiver & Release Form

Please complete this form before your first class at 10th Planet Bastrop

Personal Information

First Name *

Last Name *

Email Address *

Phone Number *

Date of Birth *

Gender

Address *

City *

State *

Zip Code *

Emergency Contact Information

Emergency Contact Name *

Relationship *

Emergency Contact Phone *

Emergency Contact Email

Medical Information

I have medical conditions, injuries, or physical limitations that may affect my participation in martial arts activities

I have received physician approval to participate in martial arts activities

Waiver and Release of Liability

ASSUMPTION OF RISK, WAIVER OF CLAIMS AND INDEMNIFICATION AGREEMENT

I understand that participation in martial arts, Brazilian Jiu-Jitsu, and related activities at 10th Planet Bastrop involves inherent risks including but not limited to:

Risk of injury from physical contact with other participants
Risk of injury from equipment, mats, and training surfaces
Risk of muscle strains, sprains, fractures, and other injuries
Risk of cuts, bruises, and abrasions
Risk of more serious injuries including concussion or death

ACKNOWLEDGMENT OF RISK: I acknowledge that I have been informed of and understand the nature of martial arts training and the inherent risks involved. I voluntarily assume all such risks.

RELEASE OF LIABILITY: In consideration for being permitted to participate in activities at 10th Planet Bastrop, I hereby release, waive, discharge and covenant not to sue 10th Planet Bastrop, its owners, instructors, employees, agents, and representatives from any and all liability, claims, demands, actions or rights of action for damages, losses, or injuries that may occur during my participation.

INDEMNIFICATION: I agree to indemnify and hold harmless 10th Planet Bastrop from any loss, liability, damage or cost incurred as a result of my participation in activities.

MEDICAL TREATMENT: I consent to receive medical treatment which may be deemed advisable in the event of injury while participating in activities. I understand that I am responsible for all medical costs.

PHOTOGRAPHY/VIDEO CONSENT: I grant permission for 10th Planet Bastrop to use photographs or videos of me taken during activities for promotional purposes.

BINDING AGREEMENT: This agreement shall be binding upon my heirs, estate, assigns, and personal representatives. This agreement shall be governed by Texas law.

ENTIRE AGREEMENT: This document contains the entire agreement between the parties and supersedes any prior understanding or representation of any kind.

I have read and fully understand this waiver and release agreement. I voluntarily agree to its terms and conditions. *

I confirm that I am 18 years of age or older, or if under 18, this form has been signed by my parent or guardian. *

I consent to the use of photographs and videos for promotional purposes

Digital Signature

Full Name (This will serve as your digital signature) *

Date *

By typing my name above, I acknowledge that this serves as my legal digital signature on this waiver and release form. *

By submitting this form, you acknowledge that you have read, understood, and agree to all terms and conditions outlined in this waiver.

After submission, you will receive a confirmation email with a copy of your waiver.