Element MMA Waiver

Student Information

Full Name: {name}

Date of Birth: {dob}

Address: {address}

Phone Number: {phone}    

EMERGENCY CONTACT:   Name: {contact_name}  Relationship: {contact_relation}

EMERGENCY CONTACT:   Phone: {contact_phone}

AGREEMENT AND RELEASE FROM LIABILITY 

1. Voluntary Participation. I acknowledge that I have voluntarily applied to participate in training to learn and practice self-defense techniques, martial arts and fitness activities at the premises of Element MMA, LLC, a California limited liability company, doing business as Element MMA (ELEMENT MMA), located at 5409 Central Ave, Suite 1&2, Newark, CA 94560. 

2. Assumption of Risk. I AM AWARE THAT PARTICIPATION IN SELF-DEFENSE and or FITNESS ACTIVITIES IS A HAZARDOUS ACTIVITY. I AM VOLUNTARILY PARTICIPATING IN SAID ACTIVITIES WITH KNOWLEDGE OF THE DANGER INVOLVED; HEREBY AGREE TO ACCEPT ANY AND ALL RISKS OF INJURY, ILLNESS OR DEATH, AND VERIFY THIS STATEMENT BY AGREEING BELOW.

3. I agree that ELEMENT MMA is also not responsible for any loss of or damage to personal property. 

4. I understand that the exercises provided by ELEMENT MMA may be extremely demanding and I take full responsibility for knowing, monitoring and acting within my abilities and learning and incorporating any modifications or adaptations necessary to proceed with such activities in a safe and appropriate manner. 

5. I understand that in undertaking in MMA, Fitness and Self Defense Training that there is a risk of communicable Skin Conditions that can be passed from person to person, flooring, mats or equipment. I have read ELEMENT MMA’s Hygiene Policy, agree to all points and accept any and all risks associated. 

6. I understand that ELEMENT MMA does NOT have a childcare program, nor does ELEMENT MMA provide for the safety and care of children. I agree that I am responsible for ensuring the safety, care and protection of any children under my care, should they be present with me on ELEMENT MMA premises, including adjacent sidewalk and driveway areas. I also agree to provide a separate waiver for each minor child that may be on the ELEMENT MMA premises with me to participate in ELEMENT MMA classes or programs. 

7. Release. As consideration for being permitted by Element MMA, LLC to participate in the Self-Defense/Combat Sports/Fitness Activities and use the related facilities, I hereby agree that I, my assignees, heirs, distributees, guardians, and legal representatives will not make claim against, sue, or attach the property of Element MMA, LLC, its members, managers, directors, officers, employees, agents, contractors, and/or employees and/or other participants in the Self-Defense/Combat Sports/Fitness Activities or the owner of the premises in which the Self-Defense/Combat Sports/Fitness Activities are conducted (collectively, the "Released Parties"), on account of injury or damage resulting from the negligence or other acts, howsoever caused, by any released Party as a result of my participation in the Self-Defense/Combat Sports/Fitness Activities. I hereby release the Released Parties from all actions, claims, or demands that I, my assignees, heirs, distributees, guardians, and legal representatives now have or may hereafter have for injury or damage resulting from my participation in the Self-Defense Activities. 

8. Indemnity. To the fullest extent permitted by law, I will protect, indemnify, defend and hold the Released Parties harmless from and against any and all (a) demands, claims and/or suits made by my assignees, heirs, distributees, guardians, or legal representatives or (b) losses, damages, claims, or liability for any damage to any property or injury, illness or death of any person when such damage, injury, illness or death shall be caused in whole or in part by my negligence or willful misconduct including, without limitation, when such damage, injury, illness or death shall have been caused in part by the active or passive negligence of the Released Parties). For all purposes under this Agreement and Release from Liability, any deliberate action on the part of Element MMA, LLC, its members, managers, officers, directors, agents, employees, or contractors, taken in good faith in the exercise of such persons' assigned duties and responsibilities shall not constitute negligence or willful misconduct. 

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HYGIENE POLICY

At Element MMA we encourage the understanding of appropriate hygiene and the risks associated with person-to-person and person-to-equipment contact with all forms of training. The standards of hygiene outlined below review the  minimum requirements  to which all members are expected to adhere to at ELEMENT MMA. Skin infections are an inherent risk in Combat Sports, Self Defense and Fitness Training; Infections like; Ringworm, Impetigo, Staph, Herpes, Yeast Infections and other Skin Infections of many kinds are always possible. To lower your personal risk of infections and the possible risk of infecting others, use these hygiene tips whenever you train. When training at ELEMENT MMA you should practice the following at all times:

• If you know you have a skin infection, DO NOT TRAIN until it heals completely. If you think you may have a skin infection but are unsure discuss this with your Coach and/or Gym Owner before training so we can insure you are safe and your training partners are safe as well. When in doubt, don’t ignore or hope for the best, that bump, rash or scratch may be nothing, but it could be something. You have a responsibility to self and your training partners to find out. Ask and air on the side of caution. 

• EVERYONE should come to training sessions (whether in a GI or No-GI) in a freshly-laundered GI, Rash Guards, Shorts, Spats, T-shirts, Pants, etc. Not clothing that is just air-dried and sprayed with an odor neutralizer; it must be washed and dried every time you use it. Wear it and wash it is a simple policy. If necessary you can certainly have more than one GI, Rash guard or shorts. This includes your belts; it is not good luck to not wash your belt, its bad hygiene. Tape on your belt can always be replaced by your instructor. 

• Come to class wearing freshly-laundered accessories; knee braces, ankle supports, handwraps, etc. (If you wear these) these items are easily contaminated with bacteria and must be cared for and cleaned accordingly. 

• If your clothing, accessories or gear still smells after washing, the odor is from Bacteria and should not be worn.

• Trim your finger nails and toe nails regularly. If your nails are uncared for the scratches you create to your training partners skin will break their natural protective barrier against skin infections or the bacteria in your nails can cause skin infections as well.

• Remove any form of jewelry such as necklaces, earrings, and wedding rings before training. As these can cause open wounds for you or others.

• Wash your hands. Before and after a workout, wash your hands properly. That means using soap, lathering up (either warm or cold water is OK), and rubbing your hands for at least 20 seconds, according to CDC guidelines. Rinse well and dry.

• While you can use “Anti-Bacterial” Soaps, gels and wipes on your hands, it’s best not to use them on other parts of your body before grappling as these can be harsh on the skin and actually breakdown your skins natural flora and protective layers making you more susceptible to skin diseases.

• Unless you have an Allergy of some kind, BEFORE Grappling use the natural protective foam provided by the gym (or your own personally preferred foam) on all exposed areas of skin including; face, neck, arms, legs, etc.

• Unless you have an Allergy of some kind, AFTER Grappling use the natural Body Wipes provided by the gym (or your own personally preferred wipes) on all exposed areas of skin including your face, neck, arms, legs, etc.

• Always watch out for any form of open wounds that you may have acquired before or during training, this includes friction burns from the mats or GI. Tend to these wounds immediately as these can get infected easily in training. Always be skin-conscious before, during and after training sessions.

• Follow the “Check Your Partner” Policy. Do not grapple or train with someone that has not been checked at the beginning of class during ELEMENT MMA’s Check Your Partner Process. Before you roll, you should check your partners face, neck, arms, legs, feet, any area of exposed skin to confirm that they are free from visible infection. If parts of their body are covered by tape or band aids you have every right to ask what’s underneath and visibly inspect said area. Just because someone is a higher rank or senior student does not mean you should be intimidated or afraid to ask them questions about their skin. If you have a concern about someone you may be training with or who may be in your training session that has a potential skin condition you should immediately discuss this issue with your coach. If you are unsatisfied with the resolution do not train until you talk to a gym staff member or the gym owner has addressed the situation to your satisfaction.

• If you encounter a situation where you find you or your partner are bleeding. Stop training and care for the problem immediately. At ELEMENT MMA we have bottles of disinfectant available to decontaminate areas of the mat or equipment that has come into contact with blood. 

• Shower ASAP. After a workout, resist the urge to crash on the sofa or go out to eat in your sweaty clothes. Take a shower as soon as you are able after a training session. Bacteria love to breed in your sweaty clothes. Shower thoroughly and dry off with a clean towel. Then put on dry, clean clothes.

• If you are participating in multiple training sessions per day; change into clean fresh clothes between each training session.

• Protect your feet. No Bear Feet Allowed in the Rest Rooms. Wear sandals, flip flops or any form of footwear when using the restrooms. When off the grappling mats wear footwear. Wash your feet and dry them thoroughly, especially between your toes. Athletes Foot while a common skin condition, people sometimes don’t understand or realize that it’s that fungus that contributes to Ringworm. If you’re experiencing a case of Athletes Foot, don’t train in your bare feet.

• While certainly not a “skin” centric issue; If you are sick, have the flu or some form of contagious illness DO NOT TRAIN until you are better.

• Don’t share personal care items. Don't share towels, water bottles, soap, razors, combs, brushes, or make-up. Anything that comes into contact with someone else's skin could be contaminated with Bacteria or fungus.

• All sweaty clothing and equipment should be taken out of your bags when you get home, and set aside to be washed. Wash your gym bag too if possible.

By signing this policy, I agree that I have read these points and understand the gyms expectations for my continued involvement in the program. I agree and understand that the gym has the right to discontinue my membership for violations of this policy and for gym policy. I also acknowledge that I am voluntarily participating in said activities with knowledge of the risks and dangers involved. I hereby agree to hold ELEMENT MMA and its subsidiaries harmless. I HEREBY AGREE TO ACCEPT ANY AND ALL RISKS OF INJURY, ILLNESS OR DEATH, AND VERIFY THIS STATEMENT BY AGREEING BELOW.

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COVID 19 AGREEMENT AND RELEASE FROM LIABILITY

The symptoms of COVID-19 include but are not limited to; fever, dry cough, fatigue, loss of appetite, loss of smell, and body ache. In some people, COVID-19 causes more severe symptoms like high fever, severe cough, and shortness of breath, which often indicates pneumonia.

MONITORING & MANAGEMENT OF SYMPTOMS/EXPOSURE:

I, the undersigned , understand that any presentation or experience on my part of any symptoms of COVID-19 requires immediate exit from the gym facility. I acknowledge that no third either party, from the facility or otherwise, will be capable of monitoring my symptoms, and it is my responsibility to be continually cognizant of all symptoms and interactions with other individuals who may have been exposed at all times. I agree that I will remove myself from participation and seek medical treatment of my own accord should I have any concerns regarding possible symptoms of COVID-19. 

LIMITING COMMUNITY SPREAD:

I, the undersigned , agree to monitor myself in a manner that is outlined by the CDC, Federal, State, Local and the Gyms Guidelines to be accountable for my actions and to limit community spread. I acknowledge and understand that I am the only individual capable of determining if I am experiencing COVID-19 symptoms. I hereby agree and do willingly assume responsibility for any risks that I expose myself to and accept full responsibility for any illness, injury or death that may result from participating in this significantly demanding physical activity. I for myself and on behalf of my heirs, assigns, personal representatives and/or next of kin, forever WAIVE, RELEASE, DISCHARGE and COVENANT NOT TO SUE Element MMA / CrossFit ELEMENT MMA and/or their officers, directors, representatives, partners, officials, principals, agents or employees, subsidiaries, or assigns, as well as their independent contractors for any and all claims, demands, damages and causes of action of any nature whatsoever related to my participation in those activities.

I agree to the following additional safety guidelines:

• Check in with a team member when entering the gym

• Agree to have my Temperature Checked before being allowed to work out (When Required)

• Wear Mask (When Required)

• Wash my hands before and after my workout or use provided hand sanitizing stations

• Respect the Social Distancing requirements (When Required) 

• Wipe down all equipment before and after use with disinfectant supplies provided

• Provide my own water bottle

Knowing and Voluntary Execution.  I HAVE CAREFULLY READ THIS RELEASE AND FULLY UNDERSTAND ITS CONTENTS.  I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN ME AND ELEMENT MMA, LLC AND SIGN IT OF MY OWN FREE WILL.

Name of the member or guardian signing the document:

Date: {sign_date}