Woman Only

KOP MUAY THAI — ADULT MEMBERSHIP AGREEMENT

MEMBER DETAILS

Full Name: {name}

Date of Birth: {dob}

Address: {address}

Phone: {phone}

Emergency Contact: {contact_name}

Emergency Contact Phone: {contact_phone}

MEMBERSHIP DETAILS

Membership: {membership_title}

Start Date: {start_date}

Membership Fee: {membership_fees}

Payment Frequency: {membership_recurrence}

Total Amount, if applicable: {membership_total_amount}

MEDICAL INFORMATION

Please list any medical conditions, injuries, allergies or medication that the coaches should know about.

Write “None” if there is nothing to declare:

MEMBERSHIP AGREEMENT

I confirm that I am at least 18 years old and believe I am fit to train.

I understand that Muay Thai and fitness training involve physical exercise and contact. Injuries may occur, including bruises, sprains, broken bones, concussion or other serious injuries.

I agree to follow all coaching instructions, gym rules and safety requirements.

I understand that sparring and contact training are optional and must be approved by a coach.

I agree to pay the membership fees shown above.

I understand that at least 30 days’ written notice is required to cancel my membership and that payments may continue during the notice period.

I understand that membership freezes are only available for medical reasons, require medical evidence and do not begin until approved in writing by KOP Muay Thai.

To the fullest extent permitted by law, I agree not to hold KOP Muay Thai, its owners, coaches or staff responsible for injury, illness, loss or damage arising from my participation. This does not exclude responsibility that cannot legally be excluded.

I have read, understood and agree to the waiver, gym rules, payment, cancellation and freeze terms above.

PHOTO AND VIDEO CONSENT — OPTIONAL

Leave this box unticked if you do not give permission.

I give KOP Muay Thai permission to use photos or videos of me for its website, social media and marketing.

Signed Name:

Date Signed: {sign_date}