Liability Release

DIVAS IN DEFENSE, INC.

Liability Waiver and Release, Assumption of Risk

Full Name:

First Name


Last Name

Address 1:


Street Address

Address 2:


(Apt., Suite, Box, Unit, etc.)

City:

State:


Zip Code:

Email:


ex: myname@example.com

Phone Number:


ex: (555) 555-5555

Please enter today's date:

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Day


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Are You 18+?

In consideration of being permitted to participate in the activities conducted and hosted by Divas In Defense Inc., I agree as follows on behalf of myself, my personal representatives, heirs, beneficiaries and assigns.

I ACKNOWLEDGE AND AGREE that my participation with Divas In Defense Inc. is for the purpose of learning self-defense techniques and/or firearm & stun gun training; the practice of self-defense is the physically strenuous, dynamic, and challenging practice of self defense which includes, but is not limited to, punching, kicking, striking and grappling, both individually and with partners. I further understand that such activity includes inherent dangers including serious bodily injury, permanent disability, paralysis or death which may be caused from my actions or inactions, the actions or inactions of others or the conditions of the facility in which the activity is conducted; I understand there may be other risks or other social or economic losses either not known to me or readily foreseeable at this time; and I FULLY ACCEPT ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES incurred as a result of my participation in the activity. I have consulted with my physician prior to engaging in the practice of self-defense and/or firearm & stun gun training and I am qualified, in good health and proper physical condition to participate in such activity. I am responsible for monitoring my own activity level and maintaining awareness of my own physical limitations. I further agree that I will immediately discontinue participation in any activity which I perceive to be unsafe for any reason.

I HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE AND AGREE TO HOLD HARMLESS Divas In Defense Inc., its administrators, members, directors, agents, officers, volunteers, employees and other participants, owners and lessors of the premises on which the activity takes place (each considered a "Releasee") from all liability, claims, demands, losses or damages on account caused or alleged in whole or in part by any act or omission of the Releasees in connection with the activities described above, whether or not caused in whole or in part by the negligence of any Releasee, including rescue operations, and further agree that if, despite this release, I or anyone on my behalf makes a claim against any Releasee, I will indemnify, save and hold harmless each of the Releasees from any litigation expenses, attorneys fees, loss liability, damage or cost as may occur as the result of such claim.

I agree to abide by all rules and regulations of Divas In Defense Inc., and to exercise caution and restraint when practicing self-defense and/or firearm & stun gun training individually and with other students. I agree to immediately report any unsafe conditions which come to my attention, including but not limited to the floor or any equipment. Any intentional act to injure another participant is expressly prohibited. Divas In Defense Inc. reserves the right to dismiss any participant at any time for any reason.

I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY; I INTEND IT TO BE A COMPLETE RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID THE BALANCE SHALL CONTINUE IN FULL FORCE AND EFFECT.

I, the undersigned, agree to pay the above amount according to the Card Issuer Agreement.

I, the undersigned, grant permission for my/our name(s), photographic image, and/or quotations to be published in print (including, but not limited to newsletters, brochures, newspapers, etc.), on the internet, shown on television, or used in videos, in conjunction with Divas In Defense events, DVD sales, promotional material, and/or other marketing media.

MINOR RELEASE

(e-Signature of ADULT REQUIRED)

I AM THE MINOR'S PARENT AND/OR LEGAL GUARDIAN AND HAVE THE AUTHORITY TO EXECUTE THIS WAS WAIVER ON HIS/HER BEHALF. I UNDERSTAND THE NATURE OF SELF-DEFENSE AND ITS PRACTICE AS DESCRIBED ABOVE AND THE MINOR'S EXPERIENCE AND CAPABILITIES; I BELIEVE THE MINOR TO BE QUALIFIED, IN GOOD HEALTH, AND IN PROPER PHYSICAL CONDITION TO PARTICIPATE IN SUCH ACTIVITY.

I hereby adopt and fully incorporate the entirety of the above WAIVER OF LIABILITY AND RELEASE, ASSUMPTION OF RISK on the minor's account and behalf, releasing all Releasees in the manner and upon the terms described above on behalf of the minor, his/her parents/guardians, personal representatives, heirs, beneficiaries, and assigns.

Signature

UA-60998580-1