The Art of Personal Safety

Registration/Contract, Injury Waiver, and Release of Liability and Agreement to Indemnify

Today's Date: *

Participant's First Name: *

Participant's Last Name: *

Participant's Email *

Participant's Age: *

Participant's Date of Birth: *

Participant's Cell: *

Address: *

City: *

State: *

Zip: *

INJURY WAIVER AND RELEASE OF LIABILITY AND AGREEMENT TO INDEMNIFY *

INJURY WAIVER: *

The participant, the parent, or the legal guardian on behalf of the participant, acknowledges and is fully cognizant of all the inherent dangers in connection with the execution of Combative Arts and acknowledges that the execution of Combative Arts requires physical exertion and contact, and realizes that there is a risk of physical injury which may be incurred while engaged in this activity. The participant, parent, or legal guardian on behalf of the participant, hereby waives any and all claims for any physical injury in connection with ART OF PERSONAL SAFETY PROGRAM and expressly assumes the risk of all dangers or injury inherent to the Combative Arts. *

RELEASE OF LIABILITY AND AGREEMENT TO INDEMNIFY: *

I do hereby agree to participate in the ART OF PERSONAL SAFETY PROGRAM. I recognize the risks of injury that are common to any hand-to-hand combative arts program that my child or I participate in and I do hereby waive and release the ART OF PERSONAL SAFETY PROGRAM. *

Specifically, participant agrees to release and will hold harmless and fully indemnify instructor and its representatives and/or agents for any claims or judgments which might arise in any way from any and all claims or causes of action relating to any injury to the participant, or caused by the participant to a third party or property, which may occur from participant’s participation in said program. In the event that any person or entity asserts a claim against instructor, its representatives, and/or agents, relating to participant’s injury or damage arising from participation in said program, instructor shall appoint an attorney to represent its interests and customer shall pay all of instructor’s attorney fees, payments, court costs, expert fees, deposition costs, and related litigation expenses, including but not limited to appeals and appeal bonds, within thirty (30) days after written demand by instructor. *

Participant should consult a physician before beginning this or any other exercise program. The activities, physical or otherwise, involved in this program may be too strenuous for some and could result in injury. If participant develops any pain or abnormal symptoms during, or resulting from, the above-referenced program, participant should consult his/her physician. *

Participant understands that participation in the physical activities of the ART OF PERSONAL SAFETY is at participant’s discretion, and participant is expected not to exceed his/her own physical limitations. Participant will inform instructor of any and all history of medical disabilities and any condition of which participant suffers or has suffered. Participant understands that participation in the ART OF PERSONAL SAFETY or other physical training is voluntary and involves a wide variety of risks. This is a “hands-on” program where the instructor will be simulating attacks and executing defensive moves to simulate personal safety techniques. In order to properly teach and instruct the ART OF PERSONAL SAFETY it may be necessary for participants and instructors to physically engage each other, including but not limited to physical contact. If, for any reason, participant finds this contact to be unwelcome, uncomfortable, or intrusive, participant MUST notify instructor immediately. *

INSTRUCTOR and those acting under its authority reserve the right to use photographs, videotapes, artwork or other likenesses of the PARTICIPANTS for marketing, trade, publishing, or any other lawful purpose. *

The ART OF PERSONAL SAFETY PROGRAM, takes a Life Strategies Coaching approach to training the Art of Personal Safety. There will be NO certifications or belts awarded. This is a hands-on program where participants will learn to defend themselves mentally, emotionally, and physically against potential attackers utilizing the ART OF THE 8 LIMBS PHYSICAL FITNESS TRAINING as the “physical” training platform. *

Please Note: Instructor’s instructions and advice are in no way intended as a substitute for medical counseling. *

I have indicated that I have read the INJURY WAIVER and RELEASE OF LIABILITY and AGREEMENT TO INDEMNIFY, and I fully understand the contents and typing my full name below will act as my "Signature" of signing this document. *

Typing your full name above will act as your signature.

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