Ultimate Self Defense Registration & Waiver of Liability Form

1. Assumption of Risk
I am aware and understand that, in general, martial arts is an intrinsically dangerous and hazardous activity, and in particular, the instruction, techniques and methods of jiu jitsu, karate, judo, and self defense and The Ultimate Self Defense & Performance Center, Inc.. I shall be learning and participating in all such activities as a member of The Ultimate Self Defense & Performance Center, Inc. I acknowledge herein that participating in activities contemplated by this document involve an extremely dangerous and hazardous enterprise. I am voluntary and of my own free will submitting this application for membership, becoming a member and learning and participating in The Ultimate Self Defense & Performance Center, Inc. programs with full knowledge and understanding of the serious danger and hazards involved. I hereby consent and agree to any physical contacts to me by my instructors, fellow students or others in the furtherance of training, practice or demonstration competition. I herby consent and agree to completely accept alone any liability whatsoever arising out of any activity relating to instruction, demonstration/competition, or practice (on or off premises). I acknowledge, confirm and verify the foregoing by placing my signature below. 

2. Health Advisory and Physical Condition
I hereby understand and acknowledge that the performance, practice and utilizations of the methods of The Ultimate Self Defense & Performance Center, Inc. involve extremely strenuous physical activity, and that I have been advised to consult a physician before commencing and undertaking any activity contemplated by this application/agreement. I hereby represent that, to the best of my knowledge, I am in good physical health and condition, sufficient to undertake the activity and practices constituting the methods of The Ultimate Self Defense & Performance Center, Inc.. If the condition of my health changes, during the time of existence of this agreement I will promptly advise my instructor or owner of The Ultimate Self Defense & Performance Center, Inc.

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3. Release
In consideration of (a) being accepted as a member of The Ultimate Self Defense & Performance Center, Inc., (b) being instructed by and The Ultimate Self Defense & Performance Center, Inc., its methods and techniques, (c) being entitled to participate in any and all of the activities conducted or sponsored in whole or in part by The Ultimate Self Defense & Performance Center, Inc., (d) being permitted to use The Ultimate Self Defense & Performance Center, Inc. facilities and equipment, whether owned or leased by The Ultimate Self Defense & Performance Center, Inc., in connection with The Ultimate Self Defense & Performance Center, Inc. methods, its training or other related activities. I hereby agree that I, my heirs, distributes, legatees, guardians, conservator, successors in interest and legal representatives will not make claim, or file action or suit in a court of law or before and administrative agency, or attach the property of (a) The Ultimate Self Defense & Performance Center, Inc., its members, instructors, trainers, employees, owners or agents seeking damage for injure or damage for injure or damage arising out of the use of any or the foregoing or in connection with activities of The Ultimate Self Defense & Performance Center, Inc.. Damages include personal injury, emotional distress and property damage. The foregoing includes punitive damages, where known or unknown, foreseeable or not, due to or resulting from acts, conduct, negligence or misfeasance of or failures to act by the release or any of the aforementioned parties.
Applicants releases The Ultimate Self Defense & Performance Center, Inc.,City of Boston, and Curley Community Recreation Center Council from any and all harm, injure or loss suffered by applicant while outside of the confines of The Ultimate Self Defense & Performance Center, Inc. facility.
The Ultimate Self Defense & Performance Center, Inc., Curley Community Recreation Center shall not be responsible for loss, theft or destruction of money, papers, or personal property of applicant or any other person except as delivered to The Ultimate Self Defense & Performance Center, Inc. for safe keeping.

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4. Severability
Should any part of this agreement be held unenforceable or in conflict with any laws pertaining to this agreement, the validity of the remaining parts or provisions of this agreement shall not be affected by such determination. This agreement is a non-assignable.
Applicants agrees to strictly follow instructions relating to the subject matter to be taught and any rules and regulations of The Ultimate Self Defense & Performance Center, Inc.
In witness whereof, the parties have signed and sealed this agreement in duplicate, each of which is deemed an Applicant

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Who will be participating?

Adult  Adult and Children  Children

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By clicking 'I Agree' below, you agree that you have read and agree with the terms of the waiver and that the information you provided is accurate. You furthermore agree that your submission of this form, via the 'I Agree' button, shall constitute the execution of this document in exactly the same manner as if you had signed, by hand, a paper version of this agreement.