WAIVER

ATTACHED BELOW IS THE WAIVER THAT A MEMBER AT AOUTH OMAHA BOXING CLUB WILL BE EXPECTED AND REQUIRED TO SIGN IN ORDER TO CONTINUE THE RIGOUROUS AND TACTICAL SPORT. 

 Waiver 

South Omaha Boxing Club Membership Form | Waiver 
First Name: _______________________Last Name: ____________________________ 
Birthdate: ________________________ Gender: __________________________ 
Phone: ____________________________ Email: __________________________________ 
Address: __________________________________________________________________ 
Member Type: 
❏ Youth (7-17 years old) 
❏ Adult (18+ years old)
Adult memberships $180.00, 1 Youth membership $150.00, 2 Youth $100.00, 3 or Youths $50.00  
Fighter status
❏ Beginner 
❏ Amateur Boxer 
❏ Pro Boxer 
❏ Coach | Trainer 
Boxing Association Membership: (circle all that apply) 
Golden Gloves   USA Boxing 
School you currently attend (if you are under 18 years old): _________________________ 
Relevant Medical Issues: (please check all that apply) 
❏ Asthma 
❏ Diabetes 
❏ Seizures 
❏ Allergy - Bee Stings 
❏ Allergy - Nuts 
❏ Allergies - Other ________________________________ 
Please list any other medical issues the trainers, coaches and volunteers should be aware of: 
______________________________________________________ 
Emergency Contact: ______________________________ Phone: _______________________            
Must be over 18 years old. 
Relationship to Member: ______________________________________________
Agreement, Waiver, Release of Negligence Liability I, the participant or parent/guardian of the above-
named participant, a minor, agree to abide by the rules of the South Omaha Boxing Club. I, the participant 
or parent/guardian of the above named  participant, a minor, agree to the following individually and on behalf of the participant: I agree that this program  involves a recreational activity, it is done at our own 
risk, and I assume the risk of any and all injury and/or damage  while engaging in said recreational activity. My assumption of risk includes, without limitation, injuries from training, competition, uneven or 
irregular playing surfaces, injuries from contact with equipment or from equipment failures, injuring from physical contact with other boxers or injuries incurred while performing the physical activities inherent in 
participation in this activity. I agree to release and discharge the released parties from all claims or causes of action (known and unknown) arising out of the negligence of the released parties, whether active or 
passive. This  waiver and release of liability includes, without limitation, injuries which occur as a result of negligence from (a) use of  any equipment, facilities or premises which may malfunction or break, (b) 
negligent maintenance of any equipment or  facilities, (c) negligent instruction or supervision, and (d) slipping and falling for any reason, including negligent  inspection or maintenance of the facility or 
premises.  By execution of this agreement, I hereby agree to indemnify and hold harmless the released parties from any loss, liability, damage or cost the released parties may incur due to participation in this 
program. I further expressly agree that the foregoing release, waiver and indemnity agreement is intended to be as broad and inclusive as permitted by law in the State of Nebraska and the United States 
and that if any portion thereof is held invalid, it is agreed that the balance shall, not withstanding, continue in full legal force and effect.  I ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS WAIVER AND 
RELEASE AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY AND EXPRESS 
ASSUMPTION OF RISK AND INDEMNITY AGREEMENT. I AM AWARE AND AGREE THAT BY EXECUTING THIS WAIVER AND RELEASE, I AM GIVING UP MY RIGHT TO BRING LEGAL ACTION OR ASSERT A CLAIM AGAINST THE RELEASED PARTIES FOR THEIR NEGLIGENCE OR FOR ANY DEFECTIVE PRODUCT ENCOUNTERED DURING PARTICIPATION. I HAVE READ AND VOLUNTARILY SIGNED THE WAIVER AND RELEASE AND FURTHER AGREE THAT NO ORAL REPRESENTATIONS, STATEMENTS OR INDUCEMENT APART FROM THE FOREGOING WRITTEN 
AGREEMENT HAVE BEEN MADE. 
Consent for Medical Treatment 
As the participant or parent/legal guardian of a participant in South Omaha Boxing Club, I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of 
Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb, or well-being of the participant. Photo Release Acknowledgement
I hereby authorize South Omaha Boxing Club to publish photographs taken of me, and my name, and likeness, for use in South Omaha Boxing Club’s print, online and video-based marketing materials, as well as other publications. I hereby release and hold harmless South Omaha Boxing Club from any 
reasonable expectation of privacy or confidentiality for myself and/or any minor child and/or children listed above associated with the images specified above. I further acknowledge that participation is voluntary 
and that neither I and/or the minor child or children will receive financial compensation of any type associated with the taking or publication of these photographs or participation in South Omaha Boxing 
Club’s marketing materials or other publications.  I acknowledge and agree that publication of said photos confers no rights of ownership or royalties whatsoever. I hereby release South Omaha Boxing Club, its 
contractors, its employees, and any third parties involved in the creation or publication of marketing materials, from liability for any claims by me or any third party in connection with my participation and/or the minor children listed above. 
❏ I have read the above agreement. 
Signature: ______________________________________________________
Signee must be a parent or guardian for youth members. Signee must be self for adult member.  

Full Name: _______________________________ 

Relationship to minor