Waiver Release and Assumption of Risk

I am aware and understand that the _____________  (“Activities”) is taught and entails risk of accident or injury. The risk may be in the form of an accident that may be serious or even fatal.

I understand that along with the possibility of personal injury that injury to property is also possible, such as, but not limited to possible loss of wages and the ability to earn such wages.

With full knowledge of the aforementioned dangers both to my person and to my property (current and future):

I hereby certify and declare that I will release and forever hold free and discharge from any liability, __________ [name], it’s owners, employees, and associates of and from all claims, demands, rights, and causes of action of any nature whatsoever which I may have or which may hereafter accrue to me, arising from and by reason of any and all bodily or personal injury, damage to property or other loss, and any consequence thereof, whether known or unknown, seen or unforeseen, resulting from my participation the Activities.

Further, knowing and understanding these risks, nevertheless I hereby agree to voluntarily assume these risks and to release and hold harmless all the persons or entities mentioned above who might otherwise be liable to me for damages. It is further understood that this waiver, release and assumption of risk is forever binding on my heirs and assigns.

My signature on this document is evidence that I have read and understand the dangers that are inherent in this martial art and that I voluntarily certify that I will not hold __________ [name], it’s owners, employees, or associates responsible for any injury whether as a result of training or not.

Student Name: __________________

Signature: ________________________

Signature of parent or legal guardian if under 18

Signature: ________________________

Print name:

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