TITLE Boxing Club Evanston Liability Waiver

General Information

First Name *

Middle Int

Last Name *

Date of Birth * 🛈 +

I am 18 years of age or older. * 🛈

Yes

Phone Number *

Pronouns

Email *

Street Address *

City *

State *

Zip Code *

Do you have participants under 18 who you are signing this waiver for? *

Yes

No

First & Last Name of minor: *

Date of Birth * +

Pronouns

First & Last Name of minor:

Date of Birth +

Pronouns

First & Last Name of minor:

Date of Birth +

Pronouns

Are you currently a member or class pack holder at TITLE Boxing Club Evanston or are you booking with ClassPass or Gympass? *

Is the participant currently a member or class pack holder at TITLE Boxing Club Evanston? *

Yes

No

How did you hear about us? If through friend or family, put their first and last name here so they get a referral credit. *

Are you a student? *

Yes

No

Do you want to be able to use more than one TITLE location? *

Yes

No

Do you want the participant to be able to use more than one TITLE location? *

Yes

No

When choosing a fitness club or gym, what 2 things are most important to making your decision? *

When choosing an activity for the participant, what 2 things are most important to making your decision? *

Which days are ideal for you to take class (check all that apply)? *

Which days are ideal for the participant to take class (check all that apply)? *

Do you have any injuries or limitations we should know about? *

Does the participant have any injuries or limitations we should know about? *

Have you ever taken a TITLE Boxing Class before? If so, where? *

What are your fitness goals? *

What do you hope the participant will gain/learn from this class? Any fitness goals? *

Do you currently have a typical fitness routine? If yes, what? If no, why? *

Does the participant have a typical fitness routine? If yes, what? If no, why? *

How often would you like to come to class? *

1 class per week

2 classes per week

3+ classes per week

How often would you like the participant to come to class? *

1 class per week

2 classes per week

3+ classes per week

Emergency Contact Information

First Name *

Last Name *

Relationship *

Phone Number *

Credit/Debit Card Information (Complete Your Cashless Profile With Us)

Please note that a debit or credit card on file is required for anyone taking a class with us at TITLE Boxing Club Evanston. We do not accept cash or contactless payment. Having a card on file facilitates any purchases you may need to make in the club, such as hand wraps, gloves, and memberships. No charges will be processed without your knowledge.

Credit/Debit card required to hold all class reservations: * 🛈

Please confirm the card associated with your account billing: * 🛈

Guest Assumption of Risk, Consent, Release, and Waiver

GUEST ASSUMPTION OF RISK, CONSENT, RELEASE AND WAIVER

Boxing and kickboxing courses offered by WLBM III, Inc., an independently owned and operated franchisee of TBC International, LLC, and its owners, employees, and instructors (collectively “Fitness Center”) could involve physical contact with other individuals and/or heavy bags, which may result in personal injury. Other programs offered by the Fitness Center, including weight lifting, aerobics and other events also present a risk in personal injury to the participant (you). In consideration of mutual agreements by which I will use the premises of WLBM III, Inc DBA TITLE BOXING CLUB®, which I acknowledge to be beneficial to me, I acknowledge and agree to the following:

I warrant and represent that I am in appropriate physical condition for the physical activities in which I will participate and that such physical activities, even noncontact activities, carry a risk of serious physical injury including substantial and permanent injuries, and/or death, and I knowingly and voluntarily assume those risks and waive in advance any claim of liability resulting from those risks. On my own behalf and on behalf of my representatives, my estate, and all persons claiming through me directly or derivatively, I hereby agree to hold harmless, release, and discharge in advance WLBM III, Inc its franchisor TBC International, LLC and all other TBC International LLC franchisees and their respective owners, officers, employees, affiliate companies, and all other participants and nonparticipants associated with those identified entities (hereinafter the "Clubs") from any injury that I may receive whether or not from the negligent or intentional acts of those persons released. Furthermore, I agree on my own behalf and behalf of my representatives, estate, successors and assigns to defend the Clubs from and against any and all claims and liability that may arise by reason of any injury or death I may sustain from participation in physical activities at the facilities of the TITLE Boxing Club operated by the Clubs, whether caused by an intentional act, or by negligence, or otherwise without limitation. This agreement to defend includes any claim, action or liability whatsoever, regardless of whether the claim is made, without limitation, by me, by someone on my behalf or by someone whose claim is derived from my injury or death. I acknowledge and agree (1) that it is my responsibility to cover any medical bills that I may incur and to cover myself with any medical insurance I may deem appropriate and (2) that I will not and cannot make any claim for medical coverage resulting from any injury or death incurred by me at the facilities of the TITLE Boxing Club owned and operated by the Clubs. The Clubs shall not be liable for any loss or theft of my personal property. I also specifically agree that the Clubs shall not be responsible for all such personal or property injuries, damages, loss or theft, even in the event of negligence, fault or failure to use due care on the part of the Clubs, and whether such negligence, fault, or failure to use due care is present at the signing of this Agreement or takes place in the future. I hereby consent to the Clubs taking photographs or video images of me while in classes or otherwise in the public premises of the Clubs and hereby irrevocably grant the Clubs the right to use my image or likeness in such images or photographs in any advertising, promotion, marketing materials including any and all social media, print media, or on the Club’s website.

Participant or Parent/Guardian Signature *

clear

Today's Date * +