Signup

In consideration of your acceptance of this form, I for myself, my heirs, executors, administrators and assigns, forever waive, release and discharge any and all rights, claims for damages, unknown, that I may have against Quiñones Muay Thai, their employees, members, or instructors, for any and all injuries in any manner arising or resulting from my participation in classes. I attest and verify that I have full knowledge of the risks involved in any martial arts, weights, exercise, and fitness programs and that I freely and voluntarily assume those risks as incident to participation, and that I will assume and pay my own medical and emergency expenses in the event of accident, illness, or other incapacity, regardless of whether I have authorized such expenses, and that I am medically and physically fit and able to participate in classes. I also give consent to Quiñones Muay Thai, its owner, teachers, employees, and other students to give minor emergency first aid and/or advice to me. I hereby release claims I have towards them for giving me such treatment. All dues and payments for classes are nonrefundable and non-transferable. Quiñones Muay Thai has the right to cancel classes and workshops due to inclement weather for the safety of Quiñones Muay Thai members. Refunds will be given for workshops but no prorates for on-going classes. I give Quinones Muay Thai permission to use any photos/videos taken of me for publicity.

Photo Release Authorization
During Quinones Muay Thai Classes, students may be interviewed, photographed
or videotaped to be used in publications, television reports, public presentations
and/or websites.
Please indicate below your preference:
(For children under 18 years of age)
I give permission for my child to be photographed and interviewed; also
permission to have my child’s name used.
I give permission for my child to be photographed but do not want my child’s
name used along with the photograph.
I do not want my child photographed or interviewed and do not what his/her
name used.
{name} 

(For Adults 18 years & Older)
I give permission to be photographed and interviewed; also permission to use
my name.
I give permission to be photographed but do not want my name used along
with the photograph.
I do not want to be photographed or interviewed and do not what my name
used.
{sign_date}