By signing this form I agree that I have been informed that I should not participate in an activity if I have any doubt of or if I am uncertain as to my current medical condition. I understand that I should always seek medical advice before starting any physical training program. I understand that the activities in which I participate are physically and mentally intense and may require extreme exertion and give rise to the possibility of injury or death. I hereby certify that I am in good health and do not suffer from any heart condition or other ailment that cold be exacerbated by the exertion involved in the activities in which I participate. I confirm and agree that I am fully aware of the risk and certify that I (my child/legal ward) am physically able to participate in this program’s activities. I further agree that I will comply with all the rules, regulations, and instructions given to me by any program instructor, assistant instructor, or corporation official.
Further, I (on behalf of my heirs, personal representatives, executor, and administrator) hereby waive, release, remiss, covenant not to sue and forever discharge from any claims and liabilities whatsoever without limitations that I have which arise against Elements of Self Defense or any operator, official, supervisor, officer, participant, agent, instructor, judge, volunteer, sanctioning entity, or employee from any expense, damage, loss, injury, liability (including attorney fees) due to my decision to participate in a school martial arts class, fitness training class, or seminar. I agree to indemnify and hold harmless the above-mentioned entities for any and all loss, injury, damage, claim, and liability. I confirm that I either have specific insurance to cover any injuries that I may sustain or that I have chosen to participate in these activities without any insurance coverage and agree to assume full responsibility for risk and bodily injury, death, and property damage. I hereby assume any and all risks, known and unknown, which may arise from my decision to participate in this activity.
I hereby agree to allow Elements of Self Defense to utilize any photograph, or audiovisual recording taken of me or my child at any class or event to promote the program. I understand that I will not be compensated in any way for use by the program. I hereby certify that I am at least 19 years of age. If I am not at least 19 years of age, the signature of my parent(s) and/or legal guardian(s) must appear below.
I understand that in the event the student listed above is significantly injured, ill, unconscious, and/or no one otherwise authorized to contact Emergency Medical
Service (EMS) personnel is present; it will be the practice of the instructor(s) to contact EMS personnel on behalf of the student. I give my permission for responding EMS and hospital personnel to begin necessary treatment. Furthermore, I agree to be financially responsible for any and all medical treatment for student listed herein.
Buyer’s Right to Cancel
THE BUYER HAS THE RIGHT TO CANCEL THE CONTINUING PORTION OF THIS AGREEMENT BY TENDERING THIRTY (30) DAYS WRITTEN NOTICE OF SUCH INTENT TO THE OPERATOR BY REGISTERED MAIL.