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 Initial Here