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New Client Details

So, you want to try Q Rules? Awesome! We’re excited to have you. Please fill out the following form before your first class.

Name

First Name

Last Name

Date of Birth

YYYY

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone

(###)

###

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How Did You Hear About Us?

Facebook Ad

Instagram Post / Story

Flyer / Poster

Walked By Studio

From a Friend

I consent to my image appearing on social media and being used in any current or future promotional materials for Queensberry Rules Boxing Studio

We occasionally take photos or videos during classes for our own promotional purposes. Your image will never be sold to or used by a third party.

Yes

Injury Waiver and Release of Liability

I, the participant specified above, HEREBY ASSUME ALL THE RISKS OF PARTICIPATING IN BOXING BOOTCAMPS (hereinafter program) OR ANY OTHER FORM OF PHYSICAL ACTIVITY offered by Queensberry Rules Boxing Studio, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault. I, the participant specified above, CERTIFY that I am physically fit, have sufficiently prepared or trained for participation in the programs, activities or events offered by Queensberry Rules Boxing Studio, and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in these programs, activities, or events onsite / offsite Queensberry Rules Boxing Studio premises. I, the participant specified above, ACKNOWLEDGE that this Injury Waiver and Release of Liability Form will be used by Queensberry Rules Boxing Studio, its program instructors, and their affiliates, and that it will govern my actions and responsibilities at said programs, activities, or events. IN CONSIDERATION of my agreement with Queensberry Rules Boxing Studio, and permitting me to participate in these programs, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) I WAIVER, RELEASE AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from any Queensberry Rules Boxing Studio program, activity, or event, THE FOLLOWING ENTITIES OR PERSONS: Queensberry Rules Boxing Studio, and/or its directors, officers, employees, volunteers, representatives, and agents, the program instructors, activity or event holders, activity or event sponsors, activity or event volunteers: (B) I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in these programs, activities, or events, whether caused by the negligence of release or otherwise. I, the participant specified above, ACKNOWLEDGE that Queensberry Rules Boxing Studio and its directors, officers, volunteers, representatives, and agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific program, activity, or event on behalf of Queensberry Rules Boxing Studio. I, the participant specified above, ACKNOWLEDGE that these programs, activities and events may involve a test of a person‘s physical and mental limits and may carry with it the potential for death and serious injury. The risks may include, but are not limited to, those caused by facilities, temperature, condition of participant, equipment, actions of other people including, but not limited to, participants, volunteers, spectators, coaches, event officials, and event monitors, and/or producers of events, and lack of hydration. I, the participant specified above, HEREBY ACKNOWLEDGE that I am fully required to provide my own medical coverage and that Queensberry Rules Boxing Studio will not be held liable for any expenses incurred for treatment of injuries while participating in these programs, activities, or events. The injury waiver and release of liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

By submitting this form, I certify that I have read and understand the Injury Waiver and Release of Liability for Queensberry Rules Boxing Studio.