Self Defense Hold Harmless Waiver

Please fill out the form below and submit, or download and print this form by clicking here! Please bring this form with you to the seminar.

Name:
Name:
Date:
Date:
Address:
Address:
Phone:
Phone:
Phone:
Phone:
I,
I,
, hereby release American Family Martial Arts, Family Karate, all parties involved with the teaching of this course, J&T Investments, and all involved with the location of the course from any personal injury, emotional or bodily harm sustained or suffered from me during, arising out of, or as a result of any activity associated with this self-defense course. I further release said individuals and involved parties from all claims of liability for any property or valuables lost, mislaid, or stolen. I do not have, to my knowledge, any physical condition or disability, other than those listed above, that would preclude my participation in this program. I understand the terms above and complete responsibility for my health and well being in this program.
Please initial the following:
I sign realizing that my participation in this self-defense course may have the potential to subject me to personal injury and bodily harm. I further have read the above statements and fully understand the contents of this release indemnity and hereby accept and agree to the terms, conditions and provisions written here.
Date:
Date: