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Dade City Location Schedule 

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Empire MMA Waiver

Agreement, Release and Waiver of Liability

EMPIRE MMA Gym & Fitness, INC.

In consideration of being permitted to participate in or assisting others in participating at EMPIRE MMA, INC., "The Gym", and related events and/or activities, please complete the following information and acknowledge your agreement to the terms and conditions.

Date of Birth
Month
Day
Year

Required to determine if parental consent is needed

Are you the participant or parent/guardian?
I am the participant (18 years or older)
I am the parent/guardian of a minor participant
Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Electronic signature acknowledging agreement to all terms and conditions

Date
Month
Day
Year
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