Release From Liability Agreement/Non-Disclosure Agreement: The Fighting Edge, Filipino Combat Systems, and Jason Borean
Release From Liability Agreement/Non-Disclosure Agreement: The Fighting Edge, Filipino Combat Systems, and Jason Borean
Date of Birth/Age:
Telephone:
Emergency #:
E-Mail/Website Address: Any Known Physical Injuries and/or Conditions? (If yes, please explain, use back of this form) In consideration for the undersigned participating in a seminar and/or private class from The Fighting Edge (hereinafter, TFE), Filipino Combat Systems (hereinafter, FCS) and/or Jason Borean in addition to other good and valuable consideration, the receipt and adequacy of which is hereby acknowledged, the undersigned and his/her heirs, executors, administrators, personal representatives, successors and assigns, hereby release TFE, FCS and/or Jason Borean, its associates, members, agents, officers, directors, servants and/or employees, and training location owners of and from any and all liability, claims, rights, demands, actions and causes of action whatsoever, arising out of or relating to any loss, damage, injury, or death that may be sustained by the undersigned, or any loss or damage that may be sustained to any property of the undersigned, which occurs at the time of such seminar/private class or which may develop or be discovered in the future whatsoever. INITIAL_____________ The undersigned further acknowledges and agrees that, due to the specialty nature of the martial arts instruction provided by TFE, FCS, and/or Jason Borean, he/she will NOT instruct, teach, reproduce, or otherwise disclose, in any manner whatsoever, to any third party, any of the martial arts instruction provided by TFE, FCS and/or Jason Borean. INITIAL_____________ The undersigned voluntarily assumes any and all risk of loss, damage, injury, and/or death that may be sustained during the seminar/private class and/or which may develop or be discovered in the future whatsoever provided by TFE, FCS and/or Jason Borean. INITIAL_____________ The undersigned understands that the instruction provided might subject the undersigned to physical, psychological, and/or mental stressors and certifies that he/she is of sufficient mental and physical condition to participate without risk of harm to the undersigned. INITIAL_____________ The undersigned further agrees that he/she has notified TFE, FCS and/or Jason Borean about any physical, psychological and/or mental conditions that may potentially make any or all activities unsafe for the undersigned to perform and has consulted a physician and/or other medical professional about such condition, if it exists to ensure there is no risk to the undersigned. INITIAL_____________ The undersigned also agrees that attendance and/or performance at the seminar/private class may be photographed, filmed and/or taped by TFE, FCS and/or Jason Borean and I waive all compensation thereof whatsoever. ALL photographs, films, tapes, and videotapes become the instant property of TFE, FCS and/or Jason Borean. INITIAL_____________ The undersigned understands and agrees that if permission is given to photograph, film, tape, and videotape the seminar/private class, that ALL original photographs, negatives, film, tape and videotapes become the instant property of TFE, FCS and/or Jason Borean and I waive all compensation thereof whatsoever. INITIAL_____________
Print Name
Other Photo ID #