Guma i Sindalu Siha – Accident Waiver and Release of Liability
Participant Name: {name}
Date of Birth: {dob}
Address: {address}
Phone Number: {phone}
Emergency Contact Name: {contact_name}
Emergency Contact Phone: {contact_phone}
Emergency Contact Relationship: {contact_relation}
Date Signed: {sign_date}
I, {name}, hereby acknowledge that I am voluntarily participating—or am the parent or legal guardian of a minor participant—in athletic training and recreational activities hosted by Guma i Sindalu Siha, LLC (operating as Guma i Sindalu Siha Ninja Gym), located at 458 S Marine Corps Dr. Unit WH-2, Tamuning, GU 96913.
I EXPLICITLY ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY AND ALL ACTIVITIES ASSOCIATED WITH, INSIDE, OUTSIDE, AND ON THE PROPERTY OF THE FACILITY. This includes, by way of example and not limitation, any risks that may arise from equipment failure, property conditions, or the negligence or carelessness of the persons or entities being released.
I acknowledge that participating in regular and extreme sports stunts, obstacle training, and fitness activities—including but not limited to ninja warrior obstacle courses, flips, jumps, salmon ladders, ropes, rings, warped walls, peg boards, weights, and high-flying obstacles—carries inherent physical risks. These risks include strains, sprains, broken bones, spinal injuries, paralysis, stroke, heart attack, permanent disabilities, or death. I acknowledge that physical exertion is required and accept that injuries can occur during athletic training.
PARTICIPANT CERTIFICATION
I certify that I (or the minor for whom I am responsible) am in good health, physically fit, have sufficiently prepared or trained for participation in this activity, and have not been advised otherwise by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my full participation in this activity. .
ASSUMPTION OF RISK
I understand that participating in any physical activity or using gym equipment involves potential risks. These risks may result from the actions, inactions, or negligence of myself or others, including but not limited to staff, coaches, volunteers, other participants, and third-party service providers
I also acknowledge risks from the condition of the facilities, training zones, equipment, temperature, weather, lack of hydration, and potential environmental or vehicular hazards. I voluntarily accept all such risks for myself or the minor participant named above.
WAIVER AND RELEASE OF LIABILITY
In consideration of being permitted to participate in activities and utilize the facility, I hereby take action for myself, my minor child/ward, my executors, administrators, heirs, next of kin, successors, and assigns as follows:
(A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability for personal injury, disability, death, property damage, property theft, or actions of any kind which may hereafter occur to me (including my traveling to and from this facility), THE FOLLOWING ENTITIES OR PERSONS: Guma i Sindalu Siha, LLC, its owners, operators, landlords, property managers, employees, coaches, volunteers, representatives, agents, activity holders, and organizers.
(B) I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in the paragraph above from any and all liabilities, claims, or demands made as a result of participation in these activities, whether caused by the negligence of the releases or otherwise.
I acknowledge that Guma i Sindalu Siha, LLC and its representatives are not responsible for the errors, omissions, acts, or failures to act of any third party conducting a specific event or activity on their behalf. I hereby consent to receive any emergency medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during participation.
PHOTO & MEDIA RELEASE
I understand that while participating in or observing activities at the facility, I or my child/ward may be photographed or filmed. I agree to allow my photo, video, or film likeness to be used for any legitimate promotional, social media, or marketing purpose by Guma i Sindalu Siha, LLC and its assigns, unless a formal written opt-out is explicitly submitted to gym management.
CONSENT TO TREATMENT
In the event of an injury or medical emergency, I authorize the staff, coaches, and representatives of Guma i Sindalu Siha, LLC to seek and consent to emergency medical treatment on my behalf or on behalf of the minor named above if a parent/guardian cannot be reached instantly. I accept full financial responsibility for any medical care rendered.
The Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under the laws of Guam.
I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND 100% OF ITS CONTENT. I AM AWARE THAT THIS IS A BINDING CONTRACT AND A RELEASE OF LIABILITY, AND I AGREE TO THESE TERMS OF MY OWN FREE WILL.
If signing for a minor, I affirm that I am the minor’s parent or legal guardian and have full, legal authority to execute this release on their behalf.
Signature of Participant or Legal Guardian:
Date Signed: {sign_date}
