WAIVER OF RESPONSIBILTY
FOR PERSONAL INJURY AND/OR LIABILITY

By signing this document, let it be it known that, I hereby waive my rights of holding
responsible any person or individual connected with my instruction in the martial arts.” The
martial arts” in this document refers to any method, technique, or style pertaining to instruction
in striking, grappling, and/or the use of weapons, as these relate to a self-defense nature.
Notwithstanding, each instructor will, to the best of their ability ensure the safety of their
students.
Any injury occurring to myself either by direct or indirect means through individual or inter-
personal contact as a result of accident, horseplay, or other circumstances at the place of
practice/ instruction, will be my sole responsibility. No participants will be held liable for any
injuries, be they in the form of personal injury to myself or injury I may accidentally cause
others.
I have reread this entire form and it has been explained to me fully. Therefore, without coercion
or duress, I affix my signature to this document with full understanding of the statements
contained herein, and I agree to be bounded by such agreement from this moment on, and for
the duration of my study with the above mentioned martial arts organization.