COMBAT SPORT AND FITNESS
(Read Carefully Before Signing)
1. Participation is Voluntary: The participant has been advised by Combat Sport and Fitness (hereinafter CSF) that participation in any and all activities are voluntary. Participant understands and agrees that, if at
any time, participant feels anything to be unsafe, including but not limited to equipment, facilities and/or activities, participant will immediately take all precautions to avoid the unsafe area, equipment, and/or activity and refuse to participate further.
2. Understand risks of participation: Participant fully understands and acknowledges that (a) There are risks and dangers associated with participation in this martial arts event which could result in bodily injury partial
and/ortotaldisability, contractionofillnessand/ordisease,paralysisanddeath,(b)thesocial,physical, mental, and economic losses and/or damages, which could result from these risks and dangers described
above, could be severe, (c) these risks and dangers may be caused by the action, inaction or negligence of the participant or the action, inaction or negligence of others, including, but not limited to, the parties named below, (d) there may be other risks not known to us or are not reasonably foreseeable at this time.
3. Acknowledge Risks of participation: Participant hereby acknowledges that this activity is very dangerous and involves the risk of serious injury and/or death and/or property damage. Each of the undersigned also expressly acknowledges that injuries received may be compounded or increased by negligent rescue
operations or procedures.
4. Acceptance of responsibility/assumption of risk of participation: P articipant accepts and assumes such risks and responsibility for the losses and/or damages following such injury, contracted illness or disease, disability, paralysis or death, however caused and whether caused in whole or in part by the negligence of CSF its owners, agents or employees, or by intentional conduct of parties not an owner, agent, judge, official,
or employee of CSF.
5. Participant Responsibilities: Participant certifies that he/she is in good health and physical condition, and does not have any communicable illnesses, conditions or diseases. Participant certifies that he/she will not participate in any activities if he/she is not in good health and physical condition. It is participant's
responsibility to be aware of the demands of the activity at all times. It is participant's responsibility to be adequately equipped and physically prepared. It is participant's responsibility to follow the instructions of judge's and tournament officials. The participant is solely responsible for his/her own personal safety.
6. Minor Participation requirements: In consideration of being permitted to participate in any way with CSF and/or being permitted to enter for any purpose any area (here in defined as any area where in admittance to the general public is prohibited), the parent(s) and/or legal guardian(s) of the minor participant named below
agree: Prior to participating at CSF, parent(s) and/or legal guardian(s) will inspect the facilities and equipment to be used, and if he or she believes anything is unsafe, the participant will immediately advise the officials of such condition and refuse to participate.
7. Release of liability/covenant not to sue: The participant hereby releases, waives, discharges, and covenant not to sue CSF, including its owners, managers, promoters, agents, lessees of premises used to conduct the martial arts event or program, premises and event inspectors, owners and managers of the facility used for CSF, underwriters, consultants and others who give recommendations, directions or instructions to engage in risk evaluation or loss control activities regarding the facility or event held at such facility and each of them,
their directors, officers, agents, employees, from all liability to the undersigned. This includes but is not limited to my/our personal representatives, assigns, executors, heirs and next to kin for any and all claims, demands, losses or damages and any claims or demands therefore on account of any injury. This includes but is not limited to the death of the participant or damage to property, arising out of or relating to the events(s)
caused alleged to be caused in whole or in part by the negligence of the releasee or otherwise.
8. ReleaseappliestoallpartiesassociatedwithCSF:Thisreleaseappliestoallpartiesincluding CSF,Jeff Hougland, individually and his marital community, any designated staff, officials, judges, affiliated organizations, the owners and officers of these organizations, the instructors, and the owners and managers of the property location.
9. Release construed broadly: Each of the undersigned further expressly agrees that the foregoing release, waiver, and indemnity agreement is intended to be as broad and inclusive as is permitted
by the law of the Province or State in which the event is conducted and that if any portion is held invalid, it is agreed that the balance shall, notwithstanding continue in full legal force and effect. This release also applies to any dependants, parents, heirs, guardian, family or any other party having the right to pursue any and all claims on my behalf.
10. Parent must defend, indemnify, and hold harmless CSF for minors: On behalf of the participant and individually, the undersigned partners(s) and/or legal guardian(s) for the minor participant executes this Waiver and Release. If, despite the release, the participant makes a claim against any of the Releasees, the parents(s) and/or legal guardian(s) will reimburse the Releasee for any money which they have paid to the participant, or on his behalf, and hold them
11. Release applies to family, heirs etc: This release applies to any claim the participant or any
parent, guardian, family member, dependant, heir or any other part}' having the right to make a claim on behalf against CSF, Jeff Hougland, individually and his marital community, any designated staff, officials, judges, affiliated organizations, the owners and officers of these organizations, the instructors, and the owners and managers of the property location.
12. Only sanctioned use of skills: Participant understands that the skills used at CSF are solely in
accord with the law. Participant is solely responsible for his/her actions at CSF, and agrees to defendant and indemnify CSF, Jeff Hougland, individually and his marital community, any designated staff, officials, judges, affiliated organizations, the owners and officers of these organizations, the instructors, and the owners and managers of the property location for any of my actions that result in claims.
13. Model Release: I agree that CSF may use my image, photo, likeness for any purpose, including but not limited to: CSF website, promotions, tournament video/DVD sales, instructional videos,
14. Release of personal property loss: I am responsible for my owner personal property and agree to release and hold harmless CSF, Jeff Hougland, individually and his marital community, any
designated staff, officials, judges, affiliated organizations, the owners and officers of these organizations, the instructors, and the owners and managers of the property location for any losses of personal property'.
15. CSF Right to prohibit practice or participation: CSF staff, owners, officials, organizers, judges reserved the right to prohibit participation for any reason without providing a refund.
16. Validity of release: If any portion of this agreement shall be held invalid, illegal or unenforceable to any extent and for any reason by any Court of competent jurisdiction the remainder of this agreement shall not be affected thereby and shall be enforceable to the full
extent permitted by law.
personal medical insurance and/or participant understands that they are solely responsible for then-own medical bills and any injury regardless of the cause.
I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WTHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAM'.
I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THIS STATEMENT IS TRUE AND CORRECT.
Participant: _________________________________________ Date ______________
Participant or Guardian 's Signature (for minor)
Printed Name of Participant: ________________________________________________ Address:____________________________________________________
City:____________________________ State:______ Zip:_____________ Email:______________________________________________#____________________
Emergency Contact:___________________________________#____________________ Medications/Conditions:_____________________________________________ _______ Previous Experience: Y / N Years:____________