Waiver Participant's Name* First Last Date of Birth* MM slash DD slash YYYY Email* Phone*Special ConsiderationsPlease let us know of any custodial/medical instructions, allergies, etc.Media Release* I understand photos are taken in the studio and used for promotional purposes and on social media. Waiver* I have read and accept the terms of the Waiver, Release of Liability and Indemnity. WAIVER, RELEASE OF LIABILITY AND INDEMNITY The instruction and exercise programs offered by Nomad Holistic Wellness Studio, have been designed with safety in mind but entail certain inherent risks to the health and safety of participants. In consideration of being allowed to participate in any way in Nomad Holistic Wellness Studio programs, related events and activities, the undersigned acknowledges and agrees as follows: I agree to waive any and all claims that I have or may in the future have against, and RELEASE FROM ALL LIABILITY AND AGREE NOT TO SUE, Nomad Holistic Wellness Studio, or any of their respective officers, directors, employees, representatives or agents (collectively, the “Released Parties”) for any loss, property damage, expenses or personal injury (including death) that I may suffer, or that my next of kin may suffer, as a result of or in any way connected or related to my use, whether supervised by the Released Parties or not, of the facilities, equipment, classes and instruction provided by the Released Parties (collectively, “My Use” DUE TO ANY CAUSE WHATSOEVER INCLUDING, BUT NOT LIMITED TO: negligence on the part of the Released Parties; breach of any other duty imposed by law; breach of contract; and/or mistakes or errors in judgment by the Released Parties. I agree to hold harmless and fully indemnify the Released Parties from any and all liability for any loss, property damage, expenses and personal injury (including death) to any third party or myself resulting from or in any way related to My Use. I acknowledge and agree that My Use may involve the practice of martial techniques, engagement in combat and other activities, that may not be supervised by the Released Parties, and which will involve many known and unforeseen risks, dangers and hazards that could result in damage, loss or physical injury to me including, but not limited to, permanent debilitating physical and or mental injury and death. I am fully aware of the risks and hazards involved and freely accept and fully assume all such risks, dangers and hazards and the possibility of personal injury, death, property damage and all loss resulting from My Use. I willingly agree to comply with the stated and customary terms, conditions, rules and regulations for My Use. If I observe any unusual significant hazard during My Use, I will remove myself from participation and bring such hazard to the attention of the nearest representative of Nomad Holistic Wellness Studio. I confirm that I have read this document, fully understand its terms and understand that by signing this document I am freely and without inducement or assurance of any nature, waiving certain legal rights, including the right to sue or claim compensation following an accident, which I or my heirs, next of kin, executors, administrators, assigns or personal representatives may otherwise have against the Released Parties. I agree that this document is in addition to and in no way shall limit any other agreement, waiver of document that I have entered into with the Released Parties or any one of them. I agree that the laws of the Province of British Columbia will govern this document. I agree that if any portion of this document is found to be void or unenforceable, the remaining portions of this document shall remain in full force and effect. I Confirm that I am of the full age of nineteen years and that I have read and understood this document prior to signing it and agree that this document will be binding upon my heirs, next of kin, executors, administrators, assigns and personal representatives in the event of my mental incapacity or death. This is to certify that I, as parent/guardian with legal responsibility for the above named person, do consent and agree to this release, waiver and indemnity as provided above on behalf of the above named person and on my own behalf as if I were so named above. For myself my heirs, assigns, and next of kin, I release and agree to fully indemnify the Released Parties from any and all liabilities incident to such minor’s involvement or participation in respect of ‘My Use” as provided above.Signature*HiddenDate Signed MM slash DD slash YYYY Δ
