Beginner 6 week Course

KOP MUAY THAI — ADULT WAIVER, RELEASE & MEMBERSHIP TERMS (18+)

Member Name: {name}
Date of Birth: {dob}
Address: {address}
Phone: {phone}

Emergency Contact Name: {contact_name}
Emergency Contact Phone: {contact_phone}
Relationship: {contact_relation}

Membership Title: {membership_title}
Membership Start Date: {start_date}
Membership Fees: {membership_fees}
Membership Recurrence: {membership_recurrence}
Membership Total Amount (if applicable): {membership_total_amount}

1) Acknowledgement of Risk

I, {name}, understand that Muay Thai, boxing, padwork, conditioning, sparring, clinching, and related training activities are physically demanding and involve inherent risks, including but not limited to: sprains, strains, bruising, cuts, concussion, broken bones, dental injury, loss of consciousness, and in rare cases serious injury or death.

I voluntarily choose to participate and accept full responsibility for all risks, whether known or unknown, including risks arising from the ordinary negligence of the Club, its owners, coaches, staff, volunteers, or other members.

2) Health & Medical Declaration

I confirm that I am physically fit to participate in training. I will stop immediately if I feel unwell, dizzy, or injured and will notify a coach.

Please disclose any relevant medical conditions, injuries, allergies, or medication:

I confirm I have answered truthfully and will update the Club if anything changes:

3) Release of Liability (to the fullest extent permitted by law)

To the maximum extent permitted by law, I agree to release and hold harmless KOP Muay Thai (the “Club”), its owners, coaches, staff, volunteers, and related parties from any claims, demands, damages, or causes of action arising from my participation, including injury, illness, property loss, or death, except where liability cannot be excluded under applicable law.

4) Assumption of Responsibility & Safe Conduct

I agree to:

• Follow all coaching instructions and gym rules

• Train within my ability and control

• Use equipment appropriately

• Avoid reckless or unsafe behaviour

• Treat staff and members with respect

I understand the Club may refuse entry or remove me for unsafe behaviour, misconduct, or non-compliance.

5) Sparring & Contact Training Consent

I understand that sparring and partner drills involve increased contact risk.

I consent to participate in controlled contact drills and sparring when approved by coaches:
If you do NOT consent, write “NO SPARRING” here:

6) Photography / Video Consent (optional)

The Club may take photos or videos for coaching review, marketing, or social media.

I give consent for my image to be used:
If you do NOT consent, write “NO PHOTO/VIDEO” here:

7) Payment, Cancellation & Freeze Policy

I understand that membership fees are due as agreed under {membership_title}.

Membership fees: {membership_fees} (recurrence: {membership_recurrence})
Membership start date: {start_date}

A) Cancellation Policy (30 Days Notice)

To cancel my membership, I must provide at least 30 days written notice via email or through the member portal. I understand billing may continue during the notice period and cancellation takes effect at the end of that notice period.

B) Freeze (Pause) Policy — Doctor Form Required

Membership freezes are only permitted for medical reasons and require proof.

To request a freeze, I must submit a doctor’s note / medical form.

I understand:

• Freeze requests are not valid until the required medical document is provided.

• The Club may refuse a freeze request if documentation is missing or unclear.

• Fees remain payable unless and until the freeze is approved in writing by the Club.

Freeze policy acknowledgement (initials):

8) Personal Property

I understand the Club is not responsible for lost, stolen, or damaged personal items.

9) Agreement & Signature

I confirm I am at least 18 years old and have read, understood, and agree to this waiver and membership terms.

Signed Name:
Signature Date: {sign_date}
Member Initials: