ACKNOWLEDGEMENT AND RELEASE FORM
I, on behalf of myself, members of my family, my heirs, executors, administrators and assigns assume all responsibility for and all risk of damage or injury that may occur to the undersigned, as a participant or student in Victory Defense Systems, course of instruction in martial arts techniques, body conditioning and self-defense (referred to in this Assumption of Risk Agreement and Release as “Martial Arts Instruction”), while attending classes, participating in exercises, fighting opponents, performing in demonstrations, or using Martial Arts Instruction equipment, weapons and designated Martial Arts Instruction facilities (any location used for the Martial Arts Instruction or demonstrations, hereinafter referred to as “Designated Facilities”) or following Martial Arts Instruction activities in or out of Designated Facilities or traveling to or from any Designated Facilities.
I am aware Martial Arts Instruction is a hazardous activity, and am voluntarily participating in this activity with knowledge of the danger involved and hereby agree to accept any and all risks of injury.
The undersigned releases and discharges Victory Defense Systems and all Designated Facilities along with all of its designated parties, such as, but not limited to: owners, instructors, assistant instructors, other participants or students from all and all claims, demands, damages, rights of action, or causes of action, present or future, whether known or unknown, anticipated or unanticipated, and resulting from or arising out of, or incident to, the undersigned’s use (or intended use) of Martial Arts Instruction, Designated Facilities, equipment and weapons in such place or as a result of, or incident to, engaging in Martial Arts Instruction or otherwise following Martial Arts Instruction anywhere. I currently have no known physical or mental condition that would impair my capability for full participation in Martial Arts Instruction.
The undersigned acknowledges that:
1. He/She is desirous of using, as a member on a membership basis, the academy herein referred to as Victory Defense Systems.
2. He/She has received a completely executed copy of this agreement by printing or viewing this webpage.
3. He/She confirms that there were no verbal presentations other than those specified in this agreement
4. If the student is under the age of eighteen:
a. I hereby certify and represent that I am the legal guardian of the student or participant and I am legally competent to execute this Agreement.
b. I, as a parent or guardian of the student or participant, hereby represent that the facts concerning my child or ward are true and give my permission for my child or ward to participate in martial arts instruction and in such participation, agree individually and on the behalf of my child or ward to the terms of the Agreement.
c. I, as a parent or guardian of the student or participant, authorize the treatment by a qualified and licensed medical doctor of my child or ward in the event of a medical emergency which, in the opinion of the attending physician, may endanger the child’s or ward’s life, cause disfigurement, physical impairment or undue discomfort if treatment is delayed. This authority is granted only after a reasonable effort has been made to contact me. This consent is valid while the child or ward is in the care or custody of Victory Defense Systems owner or their designated instructor or staff and this is for the sole purpose of authorizing medical treatment under emergency circumstances in my absence.
I have carefully read and fully understand the contents of the forgoing Agreement and I have signed the forgoing Assumption of Risk Agreement of my own free will by signing entering my name in the webpage form.