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TAI CHI/KUNG FU/PHYSICAL FITNESS

LIABILITY RELEASE AND EXPRESS ASSUMPTION RISK 

Please read carefully before signing. 

I, (Participant Name). __{name} __ hereby affirm that I have been advised and informed of the inherent hazards of Tai Chi/Kung Fu/Physical Fitness Training. I understand that such training involves certain inherent risks: tendon and ligament injury, broken bones, head injury, blinding, orthodontic injury, joint dislocation, bruising, cuts & abrasions, sprains, cardiovascular, nerve or spinal injury, brain damage and other injuries that can occur that require treatment at an emergency medical facility, and which can result in serious injury and/or death. I further understand that such training may be conducted at a site that is remote, either by time or distance or both, from such medical facilities. I still choose to proceed with such training in spite of the possible absence of such medical facilities in proximity to the training site. 

I understand and agree that neither Michael Celeste, my instructor(s), my classmates, AFA Martial Arts, nor any other facility through which I receive my training, nor any parent or subsidiary of the foregoing, nor any of their respective employees, officers, agents or assigns (hereinafter referred to as "Released Parties") may be held liable or responsible in any way for any injury, death or other damages to me or my family, heirs or assigns that may occur as a result of my participation in this training program or as a result of the negligence of any party, including the Released Parties, whether passive or active. 

In consideration of being allowed to enroll in this training program, I hereby save and hold harmless said program, and I personally assume all risks in connection with said program, for any harm. injury or damages that may befall me while I am enrolled as a participant in this training program, including all risks connected therewith, whether foreseen or unforeseen. 

I also understand that Tai Chi/Kung Fu/Physical Fitness is a physically strenuous activity and that I will be exerting myself during this training program, and that if I am injured as a result of heart attack, aneurysm, panic, hyperventilation, trauma, tendon and ligament injury, broken bones, head injury, blinding, orthodontic injury, joint dislocation, bruising, cuts & abrasions, sprains, cardiovascular. nerve or spinal injury, brain damage and/or death that I expressly assume the risk of said injuries and that I will not hold the above listed individuals, companies or entities responsible for the same. 

I understand that this training program is designed to provide me with instruction in Tai Chi /Kung Fu/Physical Fitness. I further understand and agree that the Released Parties do not provide any guarantees and/or do not warrant that the instruction I receive will, in and of itself, affect the outcome of any self-defense situation. 

I further state that I am of lawful age and legally competent to sign this liability release, or that I have acquired the written consent of my parent or guardian. I understand that the terms herein are contractual and not a mere recitation, and that I have signed this document of my own tree act. 

IT IS THE INTENTION OF (Participant Name)

BY THIS INSTRUMENT TO EXEMPT AND RELEASE MICHAEL CELESTE. MY INSTRUCTOR(S), MY CLASSMATES, ANCIENT FIGHTING ARTS, OR ANY OTHER FACILITY THROUGH WHICH I RECEIVE MY TRAINING, AND ANY PARENT OR SUBSIDIARY OF THE FOREGOING, AND ANY OF THEIR RESPECTIVE EMPLOYEES, OFFICERS, AGENTS OR ASSIGNS, AND ALL RELATED ENTITIES, FROM ALL LIABILITY OR RESPONSIBILITY WHATSOEVER FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH HOWEVER CAUSED, INCLUDING BUT NOT LIMITED TO THE NEGLIGENCE OF THE RELEASED PARTIES, WHETHER PASSIVE OR ACTIVE. 

I CERTIFY THAT TO THE BEST OF MY KNOWLEDGE I AM NOT CURRENTLY SUFFERING FROM ANY MEDICAL CONDITION. I FURTHER ACKNOWLEDGE THAT, SHOULD I BECOME AWARE OF ANY SUCH MEDICAL CONDITION, I WILL CONSULT WITH MY PHYSICIAN BEFORE CONTINUING TO TRAIN. 

I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS LIABILITY RELEASE AND EXPRESS ASSUMPTION OF RISK BY READING IT BEFORE) SIGNED IT ON BEHALF OF MYSELF AND MY HEIRS. 

Signature of Participant _ _ Date: _{sign_date} 

Name: {name}

Address: {address}

Phone: {phone}