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RELEASE AND WAIVER OF LIABILITY

I, {name}, the undersigned hereby waive all claims against all persons associated with the Sampa Martial Arts. I understand that I am participating in a martial art that has body contact. I understand that this form of martial arts involves but is not exclusive to chokeholds, joint locks, neck cranks, joint twists, throws, slams, punches, kicks, elbows, knees, and such which could potentially cause serious injury or even death. I assume full responsibility for all my actions during and connected to the above organization. I understand the risk of participating in this form of martial arts training and with this release Sampa Martial Arts and all of its agents, employees, and associates of and from all liability, claims, demands, actions, medical bills, and causes of action whatsoever arising out of or relating to any negligent or other act or omission, and/or any loss, damage, or injury, including death, that may be sustained by the undersigned or any property of the undersigned in participating in this form of training. I, the undersigned, also state that I am in good physical condition and know of no reason why I cannot train in this form of training. I understand that in case of emergency, I hereby authorize any licensed medical personnel to perform any accepted medical assistance deemed necessary and I agree to bear the expense of any such treatment. As additional consideration for training at the Sampa Martial Arts, I agree that my attendance and performance at the academy and abroad at events and such may be photographed, filmed, and taped, and used by the Sampa Martial Arts for marketing purposes and I authorize the use of my image and I waive any compensation thereof - even if I discontinue my training at the Sampa Martial Arts. I acknowledge that I would like to receive correspondence from the academy via telephone, mail, and email. I, the undersigned, am duly aware of the risks and hazards inherent in participating in this form of martial arts degree to all its rules, terms, and conditions. I acknowledge that I have received a copy of Sampa Martial Arts’ rules and sparring rules, have read them, understand them, and agree to honor and obey them. I understand that disobeying the rules (at the instructor’s discretion), may result in suspension or expulsion from the Sampa Martial Arts and that I will not be entitled to a refund and if expelled must pay the remainder of my contract if one has been signed. In signing this foregoing release, the undersigned hereby acknowledges and represents that: he/she has read the foregoing release, understands it, and signed it voluntarily; he/she is over 18 years of age and sound mind. If under 18, the parent/legal guardian in signing this release agrees to all its terms and conditions.

(Parent/Legal Guardian if under 18 years of age)

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