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Waiver / liability release

Physical Activity Readiness Questionnaire (PAR-Q) Screening Form and Liability Waiver

For most people physical activity should not pose any problem or hazard. This questionnaire will tell you if you need to consult a doctor before starting MMA-related activities.

If you are over 50 years of age and not used to physical activity, please first check with your doctor.

Please check box if you answer YES to the questions below.

1. Has your doctor ever said that you have a heart condition and recommended only medically supervised physical activity?

2. Do you frequently have pains in your chest when you perform physical activity?

3. Have you had chest pain when you were not doing physical activity?

4. Do you lose your balance due to dizziness or do you ever lose consciousness?

5. Do you have any other health problem that causes you pain or limitations that must be addressed when exercising? (Such as: diabetes, osteoporosis, high blood pressure, arthritis, epilepsy, respiratory ailments, back problems etc.)

6. Are you pregnant now or have you given birth within the last 6 months?

7. Have you had a recent surgery? (If yes, ensure you have asked your doctor if you are limited in certain physical activity, and make your coaches aware of what this is)

8. If there is any other reason why you should not participate in physical activity, or if you have answered YES to any of the previous, please elaborate.

9a. Do you take any medications, either prescription or non-prescription, on a regular basis?

9b. If YES,
i. What is the medication for?

ii. How does this medication affect your ability to exercise?

I agree to abide by all rules, regulations, laws, agreements and commitments of Wayfarer Academy at all times. I accept and understand that participation in Mixed Martial Arts (MMA) carries the risk of injury, as in all contact sports. I declare that I am fully medically fit, both mentally and physically and understand Wayfarer Academy will not be held responsible for ANY injury or damage to my person while training, foreseen or otherwise.

I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction.

Name: {name}

Signature:

Date: {sign_date}

IMPORTANT: If at any time your health status changes so that you would then answer YES to any of the PAR-Q questions or have to take prescribed drugs, it is your responsibility to inform the coaches immediately.

Done Clear Sign Below:

Signature

Coronavirus/Covid-19 Waiver

I acknowledge the contagious nature of coronavirus/Covid-19 and that many public health authorities still recommend practicing social distancing.

I further acknowledge that Wayfarer Academy has put in place preventative measures to reduce the spread of the Coronavirus/Covid-19.

I further acknowledge that Wayfarer Academy cannot guarantee that I will not become infected with coronavirus/Covid-19. I understand that the risk of becoming exposed to or infected by coronavirus/Covid-19 may result from the actions, omissions, or negligence of myself and others.

I attest that:

I am not experiencing any symptom of illness, such as: a cough, shortness of breath or difficulty breathing, fever, chills or repeated shaking, muscle pain, headache, sore throat, or new loss of taste or smell.
I have not traveled internationally within the last 14 days.
I do not believe I have been exposed to someone with a suspected or confirmed case of coronavirus/Covid-19.
I have not been diagnosed with coronavirus/Covid-19 and not yet cleared as non-contagious by local public health authorities.
I am following all local recommended guidelines as much as possible and limiting my exposure to coronavirus/Covid-19.

Name: {name}

Signature:

Date: {sign_date}

Done Clear Sign Below:

Signature

Video & Photography Release

I, the Recorded Party, {first_name} , hereby authorise WAYFARER ACADEMY, the Released Party, the right and permission to copyright and/or publish, reproduce or otherwise use my name, voice and likeness in video, photographs, written materials and audio-visual recordings. I acknowledge and understand these materials about or of me may be used for both commercial and/or non-commercial purposes.

I understand that my image may be edited, copied, exhibited, published and/or distributed. I also understand this material may be used individually or in conjunction with other media in any medium, including without limitation to print publications, digital publications and/or public broadcast for any lawful purpose. There is no time limit on the validity of this release nor are there any geographic limitations on where these materials may be distributed.

I hereby acknowledge and grant WAYFARER ACADEMY and its employees, agents, licences, successors and third-party organisations all ownership rights and irrevocable rights and permission to use, copyright, publish, sell, distribute, and/or promote the recorded video, photo, interview and/or audio.

I understand that my participation is voluntary and that I may, at any time discontinue my involvement before signing this document. If I choose to discontinue participation, I will notify the principal parties (WAYFARER ACADEMY and any other parties involved) by providing written notice within 28 days.

I understand that WAYFARER ACADEMY can see no risk presently, and that I take full responsibility for my involvement in this project and the risks that it may entail (be they legal, physical or mental) and release WAYFARER ACADEMY from any claims, demands, losses, damages, suits and liabilities of any kind whatsoever in connection with the foregoing.

I hereby certify that I am over eighteen years of age and am competent to contract in my own name insofar as the above is concerned. If I am under eighteen years of age, my parent(s) or legal guardian(s) have read this document and have given their consent by signing below.

By signing this form, I acknowledge that I have completely read and fully understand the above consent and release and agree to be bound thereby. I hereby release any and all claims against any person or organisation utilising this material for marketing, educational, promotional and/or any other lawful purpose whatsoever.

Name: {name}

Signature:

Date: {sign_date}

Privacy Notice (what that means for you)

At Wayfarer Academy, we make frequent use of video footage and photographic stills for educational material, as well as for promotional and artistic purposes.

This is usually done digitally on social media platforms (such as Instagram, TikTok, Youtube, Facebook and Twitter) or on our websites (such as wayfareracademy.com), but in future may also include printed materials, or conjunction with third-party individuals or organisations.

This could cover anything from audio-video clip recordings to still photography to text quotes taken from the same recordings.

As such, we require permission to use recordings freely for these purposes, both now and in the future. Our uses range from educational and artistic purposes, to promotional marketing materials, and as such, we legally require both non-commercial and commercial rights to recordings indefinitely.

There is no payment given for this permission, but it is generally required as part of membership to Wayfarer Academy.

At times we may invite third-party individuals/photographers, or organisations, to also film and/or document material in the gym (such as for filming fighters who represent the gym in competition) on our behalf or in partnership, and as such, must also extend the same rights to these groups.

Your explicit consent is required for us to obtain and use images (photographs and video) of you. Signing this video release form simply allows the gym to operate freely both now and in the future, without having to worry about any legal concerns arising over compliance issues.

We take the security of your images seriously. We have internal policies in place to ensure that original digital images are not misused and to prevent unauthorised access. All original digital images taken by us are only stored on Wayfarer Academy associated electronic devices and secure computer systems. We retain your images for as long as it is necessary.

Complaints

If you have a concern over how your images are being used, please first raise a complaint with a member of our reception staff, either in person or via email at janna@wayfareracademy.com.

Our appointed Club Safeguarding Officer (CSO) is Sunnah Choudhury, you can contact her either in person or via email at sunnah@wayfareracademy.com.

If you are still dissatisfied after raising your concern with our team, you have the right to complain to the Information Commissioner Officer (ICO).

The ICO can be contacted at either https://ico.org.uk/ or:

Information Commissioner’s Office,
Wycliffe House,
Water Lane Wilmslow,
Cheshire,
SK9 5AF

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Waiver / liability release

Physical Activity Readiness Questionnaire (PAR-Q) Screening Form and Liability Waiver

Coronavirus/Covid-19 Waiver

Video & Photography Release

Privacy Notice (what that means for you)

Complaints

Medical Conditions

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