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Free Punch Session(Required)

Who is participating in the session?

I am the participant

I am scheduling the session for someone else

Participant Information

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Participant's Name(Required)

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Participation Consent(Required)

Participant is under the age of 18 & I have authority provide consent for their participation.

Participant is over the age of 18.

Participant's Health

Mental Health Check-in(Required)

Physical Health Check-in(Required)

Self-Care Check-in(Required)

Location Information

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I would like to choose the location for the session

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Waiver & Disclaimer

Punch Therapy is designed to promote stress relief and physical well-being. It is not a substitute for professional medical advice or treatment. Please consult with your physician before starting any new exercise program.

Adult Participant Waiver(Required)

I agree to the waiver

Complete Waiver and Release of Liability and Agreement to Hold Harmless from All Injury – Adult

By completing and submitting this form, I (the “Member”), HEREBY WAIVE AND RELEASE, indemnify, hold harmless and forever discharge Highly Vibrated, a California Corporation dba Punch Therapy (the “Club”), with its Principal Place of Business at 2690 State Street, Carlsbad, California 92008, and its agents, employees, officers, directors, affiliates, successors and assigns, of and from any and all claims, demands, debts, contracts, expenses, causes of action, lawsuits, damages and liabilities, of every kind and nature, whether known or unknown, in law or equity, that I ever had or may have, arising from or in any way related to my participation in any of the events or activities conducted by, on the premises of, or for the benefit of, the Club provided that this waiver of liability does not apply to any acts of gross negligence, or intentional, willful or wanton misconduct.

I understand that the activities that I will participate in are inherently dangerous and may cause serious or grievous injuries, including bodily injury, damage to personal property and/or death. On behalf of myself, my heirs, assigns and next of kin, I waive all claims for damages, injuries and death sustained to me or my property that I may have against the aforementioned released party to such activity.

By this Waiver, I assume any risk, and take full responsibility and waive any claims of personal injury, death or damage to personal property associated with the Club including but not limited to receiving martial arts lessons at the facility, using the facility and its equipment in any manner, form or fashion, and practicing and/or engaging in various martial arts, self-defense, fighting, with activities or other related activities on and off the premises.
This WAIVER AND RELEASE, on together with the Membership Agreement and Club Rules, combine and collectively incorporate by reference to each other, to contain the entire agreement between the parties, and supercede any prior written or oral agreements between them concerning the subject matter of this WAIVER AND RELEASE. The provisions of this WAIVER AND RELEASE may be waived, altered, amended or repealed, in whole or in part, only upon the prior written consent of all parties.

The provision of this WAIVER AND RELEASE will continue in full force and effect even after the termination of the activities conducted by, on the premises of, or for the benefit of the Club, whether by agreement, by operation of law, or otherwise.

I have read, understand and fully agree to the terms of this WAIVER AND RELEASE. I understand and confirm that by signing this WAIVER AND RELEASE I have given up considerable future legal rights. I have signed this Agreement freely, voluntarily, under no duress or threat of duress, without inducement, promise or guarantee being communicated to me. My signature is proof of my intention to execute a complete and unconditional WAIVER AND RELEASE of all liability to the full extent of the law. I am 18 year of age or older and mentally competent to enter into this waiver.

Child Participant Waiver(Required)

I agree to the waiver

Complete Waiver and Release of Liability and Agreement to Hold Harmless from All Injury – Child

By completing this from, I as the legal guardian (the “Parent”), on behalf of the participant under the age of 18 (the “CHILD”) HEREBY WAIVE AND RELEASE, indemnify, hold harmless and forever discharge Highly Vibrated, a California Corporation dba Punch Therapy (the “Club”), with its Principal Place of Business at 2690 State Street, Carlsbad, California 92008, and its agents, employees, officers, directors, affiliates, successors and assigns, of and from any and all claims, demands, debts, contracts, expenses, causes of action, lawsuits, damages and liabilities, of every kind and nature, whether known or unknown, in law or equity, that I or CHILD ever had or may have, arising from or in any way related to CHILD’S participation in any of the events or activities conducted by, on the premises of, or for the benefit of, the Club provided that this waiver of liability does not apply to any acts of gross negligence, or intentional, willful or wanton misconduct.

I understand that the activities that said CHILD will participate in are inherently dangerous and may cause serious or grievous injuries, including bodily injury, damage to personal property and/or death. On behalf of myself, CHILD, my heirs, assigns and next of kin, I and said CHILD waive all claims for damages, injuries and death sustained to me or my property, that I or said CHILD may have against the aforementioned released party to such activity.

CHILD has the necessary and requisite skills to participate in all facets of, and activities of and requested of this facility, except as noted below. The nature of the activities has been fully disclosed and any flyer, advertisement, or brochure relating to the participating activities is expressly made a part of this WAIVER AND RELEASE.

By this Waiver, I, on behalf of said CHILD, assume any risk, and take full responsibility and waive any claims of personal injury, death or damage to personal property associated with the Club, including but not limited to receiving martial arts lessons at the facility, using the facility and its equipment in any manner, form or fashion, and practicing and/or engaging in various martial arts, self-defense, fighting, with activities or other related activities on and off the premises.

This WAIVER AND RELEASE, together with the Membership Agreement and Club Rules, combine and collectively incorporate by reference to each other, to contain the entire agreement between the parties, and supercede any prior written or oral agreements between them concerning the subject matter of this WAIVER AND RELEASE. The provisions of this WAIVER AND RELEASE may be waived, altered, amended or repealed, in whole or in part, only upon the prior written consent of all parties.

The provision of this WAIVER AND RELEASE will continue in full force and effect even after the termination of the activities conducted by, on the premises of, or for the benefit of the Club, whether by agreement, by operation of law, or otherwise.
I have read, understand and fully agree to the terms of this WAIVER AND RELEASE. I understand and confirm that by signing this WAIVER AND RELEASE said CHILD and I have given up considerable future legal rights. I have signed this Agreement freely, voluntarily, under no duress or threat of duress, without inducement, promise or guarantee being communicated to me. My signature is proof of my intention to execute a complete and unconditional WAIVER AND RELEASE of all liability to the full extent of the law.

Medical Conditions. I have do my due diligence to inform THE CLUB that my CHILD is subject to the following allergies or medical conditions, and I authorize the facility to disclose these conditions to a physician or other medical professional in the event said CHILD should require emergency medical care.

Prohibited Activities. I have done my due diligence to inform THE CLUB if as a result of the above-mentioned medical conditions my CHILD, is prohibited from involvement in specific activities.

Phone

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