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NAME: {name}
ADDRESS:{address}

PLEASE READ the accompanying information regarding the fitness evaluation program protocols, equipment
usage and equipment testing.
1. My participation is voluntary and I may withdraw from the program at any time.
2. Any testing will be under the direction of the Johnson Combat Sports and Fitness LLC/Black Diamond Martial Arts
(referred to as BDMA) staff.
3. I acknowledge the following:
a. In the event of physical injury resulting from the evaluation procedures, equipment usage or equipment
testing, no medical treatment or monetary compensation will be provided by BDMA. I must look to my own
health insurance policy(s).
b. BDMA is relying on all information provided in any program. I certify the information provided to be true and
correct.

RELEASE OF ALL CLAIMS, WAIVER OF LIABILITY AND IDEMNIFICATION AGREEMENT
ACKNOWLEDGEMENT OF RISK AND DANGER AND ASSUMPTION OF RISK

I,{name} , understand and am aware that the use of the BDMA facility, and equipment has inherent and
unanticipated and unknown risks and dangers that may cause injuries or death. I expressly assume all risks or injury or
death that may be sustained during my use of the facilities and equipment, defects in the facilities and equipment, the
negligence of other and my own negligence or misuse. I acknowledge there is inherent risk of contracting or spreading
infectious diseases with other patrons and employees, and will take precautions to minimize that risk (washing hands,
sanitizing equipment after use, not coming into the facility when ill or having fever, etc).

Initial – if minor, parent/guardian/conservator also initial

RELEASE, COVENANT AND PROMISE NOT TO SUE
In consideration of being permitted to use the BDMA facilities, services and equipment,
I,{name} , hereby release, acquit and discharge this facility, its successors and assigns, and its offices,
directors, agents, and employees of and from all claims and liability of any kind which agree that I will not sue or
commence any action of any kind against BDMA, its successors and assigns and its officers, directors, agents, or
employees.

Initial – if minor, parent/guardian/conservator also initial

IDEMNIFICATION AGREEMENT
In consideration of being permitted to use the BDMA facilities, services and equipment,
I,{name} , agree to indemnify and hold harmless this facility, its successors and assigns, and its officers,
directors, agents, and employees of and from any claims, demands, liabilities, or judgements arising out of my use of the
BDMA equipment.
Initial – if minor, parent/guardian/conservator also initial.

PARENT/GUARDIAN/CONSERVATOR INDEMNIFICATION AGREEMENT
In consideration of my child/ward being permitted to use the BDMA facility and equipment,
I,{name} , agree to indemnify and hold harmless this facility, its successors and assigns, and its officers,
agents and employees of and from any claims, demands, liabilities or judgements made by or on my child/ward arising out
of or during my child/ward’s use of the BDMA facilities and equipment. Furthermore, I consent to my child/ward’s (under
18) use of and presence in the BDMA facility without direct parental supervision.

Initial

CONSENT TO PHOTOGRAPHY OF SELF OR MINOR CHILD/WARD

I,{name} , hereby consent or

do not consent

 BDMA to photograph or video me or my minor child/ward. I fully
understand that such photographs and videos may be used for marketing on BDMA’s websites, social media sites or
future advertising.

Initial