Signup or Log-in Student Name* First Last Is Student a Minor (under 18 years old)?*NoYesParent / Guardian Name* First Last What School Do You Attend?*Phone*Email* Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code What Style and Class Would you Like to Sign-Up For?*Kenpo Kids (4.5-6 years old)Kenpo YouthKenpo AdultArnis / Eskrima (Stick Fighting)Jiu JitsuTae Kwon DoJudoMuay Thai Martial Arts Development inc. Waiver Form Martial Arts Development (MAD) Inc., Waiver Form Student release of liability, waiver of legal rights and assumption of risk In the consideration of the opportunity to participate in events conducted by, and to use the dojo facilities, and any premises owned/leased/rented by MAD Inc. and its affiliates in the performance, instructions, lessons of Kenpo, Karate, Tai Kwon Do, Muay Thai, Judo, or any martial arts, sparring, weapons training, personal training, general exercise, and all other exercise related training (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 movement in three dimensions and that such activity is subject to mishap and even injury to or 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 forever RELEASE AND DISCHARGE MAD Inc. and its affiliates, as well as all other participants of Martial Arts, volunteers, students, MAD Inc. officers, directors, elected officials, agents, employees, and owners of equipment and land and buildings used for Martial Arts activities (hereinafter collectively referred to as ‘‘Released Parties’’), from any and all liability, claims, demands or causes of action that I or my representatives may hereafter have for injuries, loss of life, and all other forms of damages arising out of or relating to my participation in Martial Arts activities, including, but not limited to, losses CAUSED BY THE NEGLIGENCE OF THE RELEASED PARTIES. 3. I hereby forever knowingly WAIVE all claims, demands, and causes of action against the Released Parties for injuries, loss of life, and all other forms of damages arising out of or relating to my participation in Martial Arts activities, including, but not limited to, losses CAUSED BY THE NEGLIGENCE OF THE RELEASED PARTIES. 4. 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 PARTICIPATING IN MARTIAL ARTS ACTIVITIES WHETHER OR NOT CAUSED BY THE NEGLIGENCE OF THE RELEASED PARTIES. 5. I further agree that I WILL NOT SUE OR OTHERWISE MAKE A CLAIM against the Released Parties for personal injury, death, damages or other losses sustained as a result of my participation in Martial Arts activities. 6. 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 and severally, as a result of my participation in Martial Arts. 7. 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. 8. 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 9. I have read and understand the above and acknowledge that the same constitutes a full release of liability and waiver of my legal rights and also constitutes a full assumption of liability by me of all risks arising out of or relating to my engaging in Martial Arts. 10. 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 any way connected to or with the Released Parties. 11. I further represent that I am at least 18 years of age, and that I am either the Adult participant named below or else I am the parent or adult legal guardian of the Minor Child participant named below. I hereby execute this Release of Liability, Waiver of Legal Rights and Assumption of Risk on my own behalf and also on behalf of the Minor Child Participant (if any) named below, and I hereby 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 legal guardian, as the result of any injury or damage that my minor child, the minor child for whom I am legal guardian, or I myself may suffer which in any way arise from or relate to Martial Arts activities. 12. I hereby expressly recognize that this Release of Liability, Waiver of Legal Rights and Assumption of Risk 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 by any of the undersigned arising from or related to the negligence of the Released Parties. 13. I hereby agree that this Release of Liability, Waiver of Legal Rights and Assumption of Risk shall be governed by the state of California law regardless of other conflict of law principles, and that if any portion of this document shall be deemed void or unenforceable, such portion shall be severable from this document, and the remaining terms of this document shall be given their full force and effect. I HAVE READ THIS RELEASE OF LIABILITY, WAIVER OF LEGAL RIGHTS AND ASSUMPTION OF RISK AND FULLY UNDERSTAND ITS CONTENTS. I SIGN IT OF MY OWN FREE WILL AND AGREE TO BE BOUND BY IT. In place of a Signature—Please type your full Name to Confirm Your Agreement with Wavier*To be read and completed by Adult Participant or Parent/Guardian. This iframe contains the logic required to handle AJAX powered Gravity Forms.