Iron Lotus Self-Defense Waiver

 

 

 

Name: _______________________________________________ Date: _____________________

Address:________________________________________________________________________

City: ___________________________ State: ____________________ Zip: ________________

Emergency Contact: ___________________________________ Phone:_____________________

 

I, _________________________________________, hereby release Erin Lanter, all parties involved with the teaching of this course, Iron Lotus Self-Defense, and all involved with the location of the course from any personal injury, emotional or bodily harm sustained or suffered from me during, arising out of, or as a result of any activity associated with this self-defense course. I further release said individuals and involved parties from all claims of liability for any property or valuables lost, mislaid, or stolen. I do not have, to my knowledge, any physical condition or disability that would preclude my participation in this program. I understand the terms above and complete responsibility for my health and wellbeing in this program.

 

Please initial the following:

________ I understand that this course may involve strenuous physical activity and physical contact, and may be hazardous and result in personal injury.

________ I understand that, given the nature of this course, there may be fake weapons used for demonstration and scenario training. I understand the need for such tools and props in the context of the material presented and agree to their use within the course.

________ I understand that the training provided in this course will in no way guarantee that I will be impervious to an assault or attack of any kind. The above named parties and their employees will not be held liable for any damages or injuries sustained in an actual self-defense situation.

________ I understand that, depending on my personal history, participation in this course may be an emotionally traumatic experience that lasts beyond the confines of this course.

________ I understand that, at any time during the course, I am free to stand aside and not participate in any activity or part of any activity, whether it is for physical or other reasons.

________ I understand these techniques are strictly for self-defense use. I will only use the physical techniques to defend against someone in deadly force situation.

 

I sign realizing that my participation in this self-defense course may have the potential to subject me to personal injury and bodily harm. I further have read the above statements and fully understand the contents of this release indemnity and hereby accept and agree to the terms, conditions and provisions written here.

 

Signature: _________________________________________Date: __________________________

 

Signature of parent/guardian if under 18 years of age:_____________________________________