SHORT NORTH MUAY THAI, INC. WAIVER I ______________________________________, hereby recognize and acknowledge that any participation in the activities and training held at Short North Muay Thai Inc. (hereinafter "SNMT") creates an inherent risk of injury, whether caused by myself or someone else, in the activities of or presence at SNMT, the use of SNMT's equipment and participation in SNMT's classes. This risk includes, but is not limited to (a) injuries arising from participation in and use of any of SNMT's equipment, including any accidental "slip and fall" injuries; (b) injuries arising from participation in supervised or unsupervised activities and classes within SNMT's training facility or outside SNMT's training facility, to the extent sponsored by or endorsed by SNMT; (c) injuries or medical disorders resulting from exercise in SNMT's training facility, including but not limited to heart attacks, strokes, heart stress, sprains, broken bones and torn muscles or ligaments; and (d) injuries resulting from the actions taken or decisions made regarding medical procedures. I understand and voluntarily accept this risk and agree to specifically assume all risk of injury, whether physical or mental, while I am present at SNMT's training facility, using any of SNMT's equipment or services or participating in SNMT's training programs, whether such programs take place inside or outside of SNMT's training facility. I waive any and all claims or actions that may arise against SNMT, its owner, volunteers, or other participants as a result of any such injury, including and without limitation, personal, bodily or mental injury, economic loss or any damage resulting from the negligence of SNMT or anyone else using the SNMT training facility. If there is any claim by anyone based on any injury, loss, or damage that involves me, I agree to defend SNMT against any such claims and pay SNMT for all expenses relating to the claim, and indemnify SNMT for all obligations resulting from such claims. I have read the above thoroughly and understand the terms. My participation in the selected activities as well as my agreement to the foregoing are both purely voluntary and I elect to do so in spite of the risks.

________________________________________________________________________ Signature Date ________________________________________________________________________ Participant first name Participant last name ________________________________________________________________________ Day Phone Evening Phone Cell Phone ________________________________________________________________________ Address ________________________________________________________________________ City State Zip Email Address: ___________________________________________________________ Emergency contact ____________________________Phone #_____________________

Over

Office use ____MB __Y

SNMT Questionnaire Name: ________________________________________

Date:_________

How and where did you find out about Short North Muay Thai? ____Friend who?________________________ ____Website ____Other ________________________ Do you have Martial Arts experience? If so, what type _________________________________________________________ And how many years of experience?_________________________________________ What is your goal here at SNMT? ____Do you want to fight? ________________________________________________ ____Do you want to lose weight? ___________________________________________ ____Do you want to learn self-defense? _______________________________________ ____Do you want to learn the art of Muay Thai? _______________________________ Do you have any medical conditions that we need to be aware of that may cause you to be at risk? _____None _____Yes Specify ________________________________________________________________________ ________________________________________________________________________ Short North Muay Thai Rules and Financial Agreement: 1. 2. 3. 4. 5. 6. 7. 8.

No shoes, food or cell phones in gym. Wai upon entering and before leaving the gym. Never throw down your gloves, pads or equipment Always be kind and respectful to your Kru, Instructor and fellow students Do not hit the bags or pads until told No complaining No refunds given on class purchases or private sessions 24-hour cancellation notice for all private sessions. Notice must be made directly to Kru or Instructor 9. SNMT holds the right to refuse class participation if classes are not paid in full. ______ Initial here that you have read and understand the rules at SNMT.