GYM NAME PHONE NUMBER CITY / STATE

I HEREBY ACKNOWLEDGE AND AGREE that my participation in this event has inherent risks. I have full knowledge of the nature and the extent of all
the risks associated with the sport of Mixed Martial Arts which include, but are not limited to:
1. personal injury, including injuries to the head, internal organs and brain,
2. sprains, strains, broken bones, and
3. death
RELEASE / INDEMNIFICATION -In consideration of my participation in the activities of the aforementioned ght promotion (hereinafter referred to
as the Fight Promotion), I, the undersigned, on behalf of myself, my heirs, representatives, executors, administrators and assigns, do hereby release,
indemnify, and hold harmless the Global Combat Alliance (GCA), the Fight Promotion, its ofcers, agents, and employees from any cause of action,
claims, or demands of any nature whatsoever, which I, my heirs, representatives, executors, administrators and assigns may now have, or have in
the future against all parties on account of personal injury, property damage, death or accident of any kind, including any act or omission of any third
party (rescue squad, hospital, etc...), arising out of or in any way related to my participation in any and all MMA cornering activities, whether that
participation is supervised or unsupervised, howsoever the injury or damage is caused.
I further understand that neither the GCA nor the Fight Promotion provides any accident or medical
insurance and that I am nancially responsible for any and all medical expenses relating to any
and all injuries sustain as a result of my participation.
I agree that my participation in Global Combat Alliance (GCA) sanctioned events and the Fight Promation
may be photographed, lmed, and/or taped and used by GCA and/or the Fight Promotion for marketing or
other purposes and I authorize the use of my image and I waive any compensation thereof.
I further understand that the terms of this agreement are legally binding and I certify that
I am carefully signing this agreement, after I have carefully read the same, of my own free will.
PARTICIPANT SIGNATURE DATE

NAME OF FIGHTER(S) YOU WILL BE CORNERING
/ /
GCA USE ONLY
GCA OFFICIAL
INITIALS
/ /
DATE
GCA OFFICIAL
INITIALS
/ /
DATE

LAST NAME FIRST NAME MI
ADDRESS CITY STATE ZIP CODE
PHONE NUMBER EMAIL ADDRESS
EMERGENCY CONTACT NAME EMERGENCY CONTACT PHONE NUMBER
[ GCA SANTIONED EVENT ]
CORNER REGISTRATION FORM