Martial Arts Sign-up Form and Waiver

Interested in our services? Get in touch with us by filling out the form below and we'll get back to you as soon as possible! All martial arts students get a private lesson once a week. Talk with the instructor to set up a date and time. Also read the Waiver Form Listed Below! By filling out this form you are agreeing and acknowledge and accept all of the contents of the Waiver Listed Below. Dated 4/10/2010

Name*

Please tell us a little about yourself and what you would like to achieve:

Phone

Email Address

Please select a program:*

Which program works for you?

How would you like to be contacted?*

Where would you like us to teach?*

Will others be attending with you?*

Are their any medical concerns the instructors need to be aware of?*

What is your age range?*

How would you like to pay for the services provided?*

I Acknowledge, Agree, and Understand all the contents of the Waiver*

Your Signature

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Brookville Martial Arts Academy Waiver Form

Student Release of Liability, Waiver of Legal Rights and Assumption of Risk.

In consideration for the opportunity for event participation and utilization of the Dojo facilities, Brookville YMCA location, Tournament locations, and premises of the Brookville Martial Arts Academy (BMAA), and their affiliates in furtherance of karate, martial arts, general exercise, weightlifting, and all other exercise related activities, (hereinafter collectively called "Martial Arts").

I hereby understand and agree to this Release of Liability, Waiver of Legal Rights and Assumption of Risk and to the terms hereof as follows:

1. I acknowledge that Martial Arts is an action sport and recreational activity involving and utilizing your bodies full body range of motion in various degrees and that such activity is subject to mishap and even injury to or the death of participants. I understand I may suffer broken bones, internal injuries, paralysis, or fatal injury, as well as the loss of or damage to personal property while participating in the sport of Martial Arts

2. I hereby RELEASE AND DISCHARGE Brookville Martial Arts Academy (BMAA) and all related parties, other participants of Martial Arts, Volunteers, company officers, head instructor, Owner, directors, elected officials, agents and employees, and owners of equipment and the land and buildings used for Martial Arts activities (hereinafter collectively referred to as "Released parties"), from any and all liability, claims, demands or causes or action that I or my representatives may hereafter have for injuries, loss of life, and all other forms of damages arising out of my participation in Martial Arts activities, including, but not limited to losses CAUSED BY THE NEGLIGENCE OF THE RELEASED PARTIES.

3. I understand and Acknowledge that Martial Arts activities have inherent dangers that no amount of care, caution, instruction or expertise can eliminate, and I EXPRESSLY AND VOLUNTARILY ASSUME ALL RISK OF DEATH OR PERSONAL INJURY OR OTHER FORMS OF DAMAGES SUSTAINED WHILE PARTICIPATIIN IN MARTIAL ARTS ACTIVITIES WHETHER OR NOT CAUSED BY THE NEGLIGENCE OF THE RELEASED PARTIES.

4. I further agree that I WILL NOT SUE OR OTHERWISE MAKE A CLAIM against the Released Parties for damages or other losses sustained as a result of my participation in Martial Arts activities.

5. I also agree to INDEMNIFY AND HOLD THE RELEASED PARTIES HARMLESS from all claims, judgments and costs, including attorneys' fees, incurred in connection with any action brought against them, jointly or severally, as a result of my participation in Martial Arts activities.

6. I will take full responsibility for, and hold harmless Released Parties for any injury, property damage. or death that I may suffer or inflict upon others or their property as a result of my engaging in Martial Arts activities.

7. I agree that if I operate any equipment while participating in Martial Arts, I will do so in a reasonable and safe manner so as not to endanger the lives of persons or property of any individual.

8. I have read and understand the above and acknowledge that the same constitutes a release of liability and a waiver of my legal rights and also acknowledge of the assumption of liability by me and all risks arising out of my engaging in Martial Arts activities.

9. I further represent that this Release of Liability, Waiver of Legal Rights and Assumption of Risk shall continue in full force and effect for so long as I engage in Martial Arts activities which are in a way connected to or with the Released Parties.

10. I further represent that I am at least 18 years of age, or that as the parent or (Adult) legal guardian, I waive and release any and all legal rights that may accrue to me, to my minor child or to the minor child for whom I am (adult) legal guardian, as the result of injury or damage that my minor child, the minor child for whom I am (adult) legal guardian, or I may suffer while engaging in Martial arts activities.

11. I hereby expressly recognize that this Release of Liability, Waiver of Legal Rights and Assumption of Risks is a contract pursuant to which I have released any and all claims against the Released Parties resulting from participation in Martial Arts activities including any claims related to the negligence of the Released Parties by any of the undersigned.

I HAVE READ THIS RELEASE OF LIABILITY, WAIVER OF LEGAL RIGHTS AND ASSUMPTION OF RISK AND FULLY UNDERSTAND THE CONTENTS. I FILLED OUT THE MARTIAL ARTS FORM OF MY OWN FREE WILL AND AGREE TO BE BOUND EVERYTHING WRITTEN IN THIS WAIVER FORM.