EMPIRE MMA LLC
MINOR WAIVER, RELEASE OF LIABILITY, ASSUMPTION OF RISK, AND HOLD HARMLESS AGREEMENT
This Minor Waiver, Release of Liability, Assumption of Risk, and Hold Harmless Agreement is entered into by the parent or legal guardian of the minor participant listed below, in favor of Empire MMA LLC, including its owners, officers, managers, instructors, coaches, employees, contractors, volunteers, representatives, agents, members, guests, participants, affiliates, successors, and assigns.
This Agreement applies to all participation by the minor participant in activities, classes, training, private lessons, open mats, seminars, events, competitions, demonstrations, facility use, equipment use, and any related activities offered, hosted, supervised, or made available by Empire MMA LLC.
1. Minor Participant Information
Minor Participant Name: {name}
First Name: {first_name}
Date of Birth: {dob}
Phone Number: {phone}
Email Address: {email}
Address: {address}
Emergency Contact Name: {contact_name}
Emergency Contact Phone: {contact_phone}
Emergency Contact Relationship: {contact_relation}
2. Parent / Legal Guardian Confirmation
I confirm that I am the parent or legal guardian of the minor participant listed above and that I have legal authority to sign this Agreement on behalf of the minor participant.
I confirm that I am the parent or legal guardian of the minor participant and have authority to sign this Agreement on behalf of the minor participant.
3. Acknowledgment of Martial Arts and Fitness Risks
I understand and acknowledge that participation in martial arts, Brazilian Jiu-Jitsu, MMA, grappling, wrestling, striking, boxing, kickboxing, self-defense training, sparring, live rolling, takedowns, throws, submissions, chokeholds, joint locks, drilling, conditioning, strength training, cardio training, open mat, private lessons, seminars, competitions, demonstrations, and related physical activities involves inherent risks.
These risks include, but are not limited to:
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Bruises, cuts, scrapes, mat burns, and abrasions
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Muscle strains, sprains, cramps, and soreness
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Broken bones, fractures, dislocations, and ligament injuries
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Knee, shoulder, elbow, wrist, ankle, neck, back, and spine injuries
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Dental injuries, eye injuries, facial injuries, and head injuries
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Concussions, traumatic brain injuries, nerve injuries, or loss of consciousness
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Choking, restricted breathing, or injury from submissions or grappling techniques
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Exposure to blood, sweat, bodily fluids, skin infections, staph, MRSA, ringworm, viruses, bacteria, contagious illness, or other health risks
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Injury caused by equipment, mats, flooring, walls, bags, cages, training partners, instructors, guests, or other participants
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Serious bodily injury, permanent disability, paralysis, or death
I understand that these risks may arise from the minor participant’s own actions, the actions of other participants, the actions or instructions of instructors or staff, the condition of the premises, the use of equipment, physical contact, accidental contact, negligent contact, or the ordinary negligence of Empire MMA LLC or any released party.
I understand that martial arts, MMA, Brazilian Jiu-Jitsu, grappling, striking, sparring, conditioning, and related activities involve serious risks to the minor participant, including injury, illness, permanent disability, paralysis, or death.
4. Voluntary Participation and Physical Condition
I confirm that the minor participant is participating voluntarily with my permission.
I understand that the minor participant is not required to participate in any activity and may stop participating at any time.
I confirm that the minor participant is physically and mentally capable of participating in the activities offered by Empire MMA LLC.
I understand that it is my responsibility to consult with a physician before allowing the minor participant to participate if the minor participant has any medical condition, injury, illness, disability, limitation, allergy, medication concern, or other issue that could affect the minor participant’s ability to safely participate.
I agree that the minor participant will not participate while injured, ill, under the influence of any substance, or otherwise unable to safely participate.
I confirm that the minor participant is participating voluntarily with my permission and that I am responsible for determining whether the minor participant is physically and medically able to participate.
5. Assumption of Risk
On behalf of myself and the minor participant, I knowingly, freely, and voluntarily assume all risks associated with the minor participant’s participation, whether known or unknown, foreseeable or unforeseeable.
I understand and agree that these risks include risks arising from the inherent nature of martial arts and fitness activities, the actions of other participants, the condition of the premises, the use of equipment, and the ordinary negligence of Empire MMA LLC or any released party.
I voluntarily assume all risks connected with the minor participant’s participation at Empire MMA LLC.
6. Release of Liability
To the fullest extent permitted by law, on behalf of myself and the minor participant, I release, waive, discharge, and agree not to sue Empire MMA LLC, including its owners, officers, managers, instructors, coaches, employees, contractors, volunteers, representatives, agents, members, guests, participants, affiliates, successors, and assigns, for any and all claims, demands, injuries, damages, losses, liabilities, costs, expenses, attorney’s fees, or causes of action arising out of or related to the minor participant’s participation, use of the premises, use of equipment, or involvement in any activity connected with Empire MMA LLC.
This release includes, but is not limited to, claims involving personal injury, property damage, illness, infection, disability, death, and claims arising from inherent risks of the activity and ordinary negligence, to the fullest extent permitted by law.
This Agreement does not release claims that cannot legally be waived under applicable law.
I understand that I am releasing Empire MMA LLC from claims involving the minor participant, including claims arising from inherent risks and ordinary negligence, to the fullest extent permitted by law.
7. Hold Harmless and Indemnification
I agree to defend, indemnify, and hold harmless Empire MMA LLC, including its owners, officers, managers, instructors, coaches, employees, contractors, volunteers, representatives, agents, members, guests, participants, affiliates, successors, and assigns, from and against any and all claims, demands, injuries, damages, losses, liabilities, costs, expenses, attorney’s fees, or causes of action arising out of or related to:
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The minor participant’s participation in any activity
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The minor participant’s use of the premises or equipment
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The minor participant’s failure to follow gym rules or instructor directions
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The minor participant’s negligent, reckless, intentional, or unsafe conduct
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Any injury, loss, or damage caused by the minor participant to another person or property
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Any claim brought by or on behalf of me, the minor participant, family members, heirs, representatives, or assigns
I agree to defend, indemnify, and hold harmless Empire MMA LLC for claims arising out of the minor participant’s participation, conduct, or failure to follow rules or instructions.
8. Rules, Conduct, and Safety Instructions
I agree that the minor participant must follow all rules, policies, safety procedures, hygiene requirements, posted signs, verbal instructions, and reasonable directions given by Empire MMA LLC instructors, coaches, staff, or representatives.
I understand that the minor participant is responsible for training safely and within their ability level.
The minor participant must immediately release any submission when a partner taps verbally or physically, when an instructor says to stop, or when safety requires stopping.
I understand that unsafe behavior, aggressive behavior, failure to follow instructions, poor hygiene, harassment, bullying, threats, fighting outside approved training activities, or violation of gym rules may result in suspension or termination of participation without refund.
I understand and agree that the minor participant must follow all Empire MMA LLC rules, safety instructions, hygiene requirements, and coach directions.
9. Medical Treatment Authorization
In the event of injury, illness, accident, or emergency, I authorize Empire MMA LLC and its representatives to seek emergency medical treatment for the minor participant if I cannot be reached or if immediate action is reasonably believed to be necessary.
I understand and agree that I am responsible for all medical costs, ambulance fees, hospital bills, treatment expenses, rehabilitation costs, and related expenses resulting from the minor participant’s participation.
I understand that Empire MMA LLC does not provide medical insurance for participants.
I authorize Empire MMA LLC to seek emergency medical treatment for the minor participant if needed and understand I am responsible for all related costs.
10. Illness, Infection, and Hygiene
I agree that the minor participant will not participate if they have a contagious illness, fever, open wound, skin infection, rash, staph infection, MRSA, ringworm, lice, or any other condition that may pose a health risk to others.
I agree that the minor participant will maintain proper hygiene, wear clean training gear, keep fingernails and toenails trimmed, cover wounds properly, and follow any hygiene or safety requirements set by Empire MMA LLC.
I understand that Empire MMA LLC may deny participation if staff believes the minor participant may pose a health or safety risk to themselves or others.
I agree that the minor participant will not train while sick, contagious, or with any open wound, rash, skin infection, staph, MRSA, ringworm, lice, or similar condition.
11. Personal Property
I understand that Empire MMA LLC is not responsible for lost, stolen, or damaged personal property belonging to the minor participant, parent, guardian, sibling, guest, or visitor, including but not limited to phones, wallets, bags, clothing, jewelry, watches, training gear, school items, toys, water bottles, vehicles, or items left in the facility.
12. Notice to Minor Child’s Natural Guardian
THIS SECTION SHOULD BE PRINTED IN UPPERCASE TYPE THAT IS AT LEAST 5 POINTS LARGER THAN THE REST OF THIS AGREEMENT AND CLEARLY DISTINGUISHABLE FROM THE REST OF THE TEXT.
NOTICE TO THE MINOR CHILD’S NATURAL GUARDIAN:
READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO LET YOUR MINOR CHILD ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY. YOU ARE AGREEING THAT, EVEN IF EMPIRE MMA LLC USES REASONABLE CARE IN PROVIDING THIS ACTIVITY, THERE IS A CHANCE YOUR CHILD MAY BE SERIOUSLY INJURED OR KILLED BY PARTICIPATING IN THIS ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM YOU ARE GIVING UP YOUR CHILD’S RIGHT AND YOUR RIGHT TO RECOVER FROM EMPIRE MMA LLC IN A LAWSUIT FOR ANY PERSONAL INJURY, INCLUDING DEATH, TO YOUR CHILD OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A NATURAL PART OF THE ACTIVITY. YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM, AND EMPIRE MMA LLC HAS THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN THIS FORM.
I have read and understand the Notice to Minor Child’s Natural Guardian.
13. Severability
If any portion of this Agreement is found to be invalid, unlawful, or unenforceable, the remaining portions shall remain in full force and effect.
14. Governing Law
This Agreement shall be governed by the laws of the State of Florida.
15. Final Acknowledgment
I have read this Agreement carefully. I understand its terms. I understand that by signing this Agreement, I am giving up certain legal rights for myself and the minor participant, including the right to sue Empire MMA LLC for injuries, damages, losses, or death arising from ordinary negligence or inherent risks of participation, to the fullest extent permitted by law.
I sign this Agreement voluntarily and with full understanding of its meaning.
I have read this entire Agreement, understand it, and agree to be legally bound by its terms.
Minor Participant Name: {name}
Parent / Legal Guardian Signature: {signature}
Date Signed: {sign_date}