Book Session

In consideration of being permitted to participate in any way in the martial arts/self-defense program, as defined below by Empower Martial Arts and Self-Defense, located at 153 Main Street, Staten Island New York, 10307 (the "premises"). I, or, if a minor, the parent(s) and/or legal guardian of the minor participant named below (hereinafter, collecdtively, "I", "me" or "my"), enter into this Release, Liability Waiver and Indemnity Agreement ("Agreement") and herby agree:   

1. I am voluntarily seeking and consenting to participate in Empower Martial Arts and Self-Defense program, which is defined to include, but not be limited to, martial arts instruction and related training, including those in the arts of Brazilian Jiu Jitsu, ground fighting, grappling, and other martial arts that commonly involve body contact with the ground as well as techniques such as chokes and joint locks; Boxing, Kickboxing, Karate, Muay Thai, Krav Maga, Self-Defense and all Striking arts that commonly involve striking, physical, strength and/or cardio conditioning. I understand that the various activities of the Martial Arts Program may take place in, outside of, around and off the Premises, and I have the choice not to participate in any or all activities, events or competitions offered by Empower Martial Arts and Self-Defense.
2. I represent and warrant that I am either of proper physical condition to participate in all offered classes, understanding the demands and nature of the activities provided above, or accept full responsibility for my particiapation therein in my current physical state. I agree to disclose all medical conditions, ailments and other issues to Empower Martial Arts and Self-Defense prior to my participation in the program and understand that my failure to do so futher waives Empower Martial Arts and Self-Defense and it's owner Jennifer Eden Burke and all instructors and/or coaches and all landlords of the property, liability from and all injuries or other outcomes related to my continued participation in Empower Martial Arts and Self-Defense classes/program/other.
3. I fully understand and acknowledge that THE ACTIVITES OF THE MARTIAL ARTS PROGRAMS ARE INHERENTLY DANGEROUS, such that:  A)There are risks and dangers associated with my participation in the Martial Arts and Self-Defense Programs that could result in bodily injury, partial and/or total disability, paralysis or death. B) The social and economic losses and/or injuries that could result from these risks and dangers described above could be severe. C) These risks and dnagers may be caused by the action or inaction of myself or others, including, but not limited to, Empower Martial Arts and Self-Defense and/or other participants in the Martial Arts and Self-Defense Programs; the rules and regulations of the Martial Arts and Self-Defense Program; or the nature of the facilites or equipment used. D) There may be other risks and dangers not know to us or are not reasonably foreseeable at this time.
4. I understand, accept and assume the above risks and dangers, both known and unknown, and I assume full responsibility for the injuries, maladies, losses and/or damages resulting therefrom, however caused and whether caused in whole or in part by Empower Martial Arts and Self-Defense. From time to time, Empower Martial Arts and Self-Defense may host, organize or sponsor social and other extracurricular activities and events in, outside of, around and off of the Premises that may or may not be diredctly related to the Martial Arts and Self-Defense Programs. I understand that my involvement and/or participation in them is completely voluntary and agree that the terms of the Agreement shall extend to, and include, such events and activities. In the event that Empower Martial Arts and Self-Defense provides transportation to the Premises or any other locaiton where Empower Martial Arts and Self-Defense is conducting any activities, even tor gathering, I understand that my consent to be transported is compoletely voluntary and hereby agree that Empower Martial Arts and Self-Defense shall not bear any liability for any injury, loss, destruction, death or any other similar or related consequence either to my person or my property during or as a result of such transportation, whether or not foreseeable and regardless of cause. I further understand that Empower Martial Arts and Self-Defense is not obligated to provide any transportation whatsoever on any occasion, and I assume full responsibility for any. injury, loss, destruction, death or other similar or related consequence either to my person or my property during or as a result of my choice of transportation. I HEREBY FOREVER RELEASE,WAIVE, DISCHARGE AND CONVENANT NOT TO SUE Empower Martial Arts and Self-Defense, its affiliates, owners, managers, instructors, coaches, landlords, promoters, lessees, directors, officers, agents or empoloyees, from all liability for any and all claims, demands, losses or damages arising out of or relating to the Martial Arts and Self-Defense Program or any events or activities hosted, organized or sponsored by Empower Martial Arts and Self-Defense; any action or non-action undertaken by Empower Martial Arts and Self-Defense; all acts of negligence on the part of Empower Martial Arts and Self-Defense; or any rescue/emergency actions or medical treatment undertaken by Empower Martial Arts and Self-Defense, if any. This Agreement shall extend to my personal representatives, assigns, executors, heirs and next of kin.  
5. I further expressly agree that this Agreement is intended to be as broad and inclusive as permitted by law. Any portion that is uncertain or challenged as to its validity or enforceability shall be interpreted so that it most closely reflects the intent of the parties in entering into this Agreement, to the greatest extent permitted by law. Otherwise, if any portion herein is held invalid or otherwise legally unenforceable by a court of competent jurisdiction, both Empower Martial Arts and Self-Defense and I agree that the remainder of this Agreement shall remain in full force and effect.  Should any legal dispute arise out of this Agreement, or regarding any subject matter contained herein, I agree to pay for all attorney's fees and costs resonably incurred by Empower Martial Arts and Self-Defense in defense of any such dispute.
6. I give permission, free of charge, with no promise, representation or expectation of compensation, to use any photo, pictures, media, likeness of him/her for advertisement, instructional videos in any medium or matter, online training programs, or marketing materials to promote martial arts sport, martial arts fitness, self-defense or other related categories. I agree to hold Empower Martial Arts and Self-Defense harmless and reimburse Empower Martial Arts and Self-Defense for any and all costs incurred on my behalf.

I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OR RISK AND INDEMNITY AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I GIVE UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY COERCION, INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY FROM EMPOWER MARTIAL ARTS AND SELF-DEFENSE TO THE FULLEST EXTENT PERMITTED BY LAW.

Name of participant: 

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Date:

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Signature of Participant/ Parent or Guardian