Waiver of Liability

please print this page and sign

My name is _______________________________________________________ (“Student”) ,

Or, if under 18, I am the parent or guardian of ________________________________________ (“Student”)
 

I give my permission and accept full responsibility for Student to participate in Martial Art instruction (“Martial Art Instruction”) owned and operated by, NIU Wushu Kung Fu Academy (“Academy”). As a Condition to child’s participation in “Martial Art Instruction” and by signing this form, I acknowledge and agree as follows: I acknowledge and understand that there are possible hazards of “Martial Art Instruction”. The Student and I are solely responsible for deciding whether or not to participate or to rely upon any instructions, advice, or information received regarding the “Martial Art Instruction”. I acknowledge that it is not “Academy’s” purpose to teach safety before, during or after participation in “Martial Art Instruction”. I acknowledge that I am solely responsible for the decision to allow the Student to participate in the “Martial Art Instruction”. I am of legal age and mental competence to knowingly give this acknowledgment and release which shall legally bind me and the Student and our personal representatives, executors, heirs, and assigns.
 

I HEREBY RELEASE, WAIVE, AND GIVE UP ANY AND ALL CLAIMS, KNOWN AND UNKNOWN, THAT THE CHILD OR I MAY NOW OR LATER HAVE AGAINST “Academy”, ITS MEMBER(S), OFFICER(S), INSTRUCTOR(S), OPERATOR(S) AGENTS, OR REPRESENTATIVES RELATED TO ANY ACT, OMISSION, STATEMENT, OR OCCURRENCE DURING OR RELATED TO “MARTIAL ART INSTRUCTION”. CLAIMS FOREVER RELEASED BY ME AND THE CHILD INCLUDE, WITHOUT LIMITATION, LIABILITY FOR DIRECT, INDIRECT, VICARIOUS, CONSEQUENTIAL, AND INCIDENTAL, PERSONAL INJURY, DEATH, ECONOMIC LOSS AND OTHER DAMAGE OR EVERY KIND WHEREVER OR HOWEVER IT MAY OCCUR.

Date: ________________________________

Student’s Signature: __________________________________________________________

If Under 18, Parent or Guardian’s Signature: ______________________________________

Print Name: _________________________________________________________________

Address: ___________________________________________________________________

Phone: _____________________________________________________________________

Email: ______________________________________________________________________