Fill and Sign the Assumption of Risk Indemnity Agreement and Release from Liability for Participation and Training in Kung Fu Form

Assumption of Risk, Indemnity Agreement and Release from Liability for Participation and Training in Kung Fu Agreement made on __________________________ (date) , between __________________________________________ (Name of Owner of School of Kung Fu) of __________________________________________________________________________ _____________________________________ (street address, city, county, state, zip code) , referred to herein as Teacher , and _______________________________ (Name of Student) , of __________________________________________________________________________ ____________________________________ (street address, city, county, state, zip code) , referred to herein as Student . Whereas, the undersigned desires to participate in Kung Fu training and practicing the self defense art and discipline of Kung Fu under Teacher’s instruction and supervision; Now, therefore, in consideration of being allowed to participate in Kung Fu training and practice the art of self defense and discipline of Kung Fu under Teacher’s instruction and supervision and i n consideration of the mutual covenants contained in this agreement, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties agree as follows: 1. Student recognizes and understands that learning the art of Kung Fu and participating in training in this art of self defense and discipline involves taking and assuming certain risks of physical injury (including the possibility of death resulting therefrom). Despite these and other risks, and fully understanding these risks, Student hereby assumes the risk of any and all damage or injury of any kind or nature whatever (including death resulting therefrom) caused by, resulting from, arising out of, or occurring in connection with Student’s participation in Kung Fu training and practice, and learning the art of self defense and discipline of Kung Fu under Teacher’s instruction and supervision . 2. If, due to Student’s participation in Kung Fu training and practice, and learning the art of self defense and discipline of Kung Fu under Teacher’s instruction and supervision , any person including Student shall make a claim for any damage or injury (including death resulting therefrom), whether such claim be based upon the actions or inactions of Teacher or his agents, other students, or employees, including incidents of active or passive negligence, Student agrees to indemnify and save harmless the Teacher, his agents, other students, or employees, from and against any and all loss, expenses, damage or injury that Teacher or his agents, other students, or employees may sustain as the result of any such claim. 3. Student agrees that the Kung Fu curriculum to be taught and being taught by Teacher is proprietary, and Student may not teach it to others without the written permission of Teacher. 4. Student certifies that he/she is in excellent health with no medical problem that would make his/her participation in said training activities dangerous to him/her or any other person. 5. If under the age of eighteen (18) years of age, the undersigned parent or guardian assumes all obligations of Student under and pursuant to this Agreement. Witness my signature this the ____ day of _________________, 20____. _______________________________________ Signature of Student Page Two of Assumption of Risk, Indemnity Agreement and Release from Liability for Participation and Training in Kung Fu ______________________________________ Name of Student (if under 18 years of age) By___________________________________ Parent or Guardian ______________________________________ Parent or Guardian, Individually Note: All parties should also initial first page of the document.