Participant Name *

First Name

Last Name

Phone *

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth *

MM

DD

YYYY

Emergency Contact Information *

If you are a minor (under 18 years old), please have your parent or legal guardian complete the section below.

First Name

Last Name

Phone *

(###)

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I, the Parent / Guardian, hereby give my consent for the Participant Above to participate in activities at Ascension Mixed Martial Arts, LLC. I acknowledge that I have read and agree to the terms outlined in this release of liability.

*

I have read and agree to the Release of Liability Waiver and understand all terms outlined.

*

I understand that if I am a minor, I must have the consent of my parent or legal guardian before joining or participating in any activity at Ascension Mixed Martial Arts.

*

I understand and assume all risks associated with participating at Ascension MMA, including but not limited to the risk of injury.

*

I understand that by submitting this form, I am providing my legal signature and agreeing to the terms outlined in the waiver. I acknowledge that I will not hold Ascension Mixed Martial Arts, LLC, its owners, staff, instructors, or anyone affiliated with Ascension MMA accountable for any injuries sustained during participation.