Release & Waiver of Liability, Assumption of Risk, and Indemnity Agreement ** Free Class Trial is a maximum of 2 days ** Loaner uniforms are to be returned prior to leaving the class HOW DID YOU HEAR ABOUT US Driving By Internet Referral Other If Referral or Other, please provide source Student 1 * First Name Last Name Date of Birth * MM DD YYYY Student 2 First Name Last Name Date of Birth * MM DD YYYY Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Occupation Have you done ANY Martial Arts before? * Yes No If YES, which one? What are the main benefits you expect to get from your training at Gracie Gym? * Discipline Focus Strength Entertainment Confidence Balance Fitness Coordination Social Skills Self-Defense Stress Relief Other If other enter details here: GENERAL RELEASE * I hereby acknowledge and understand that Martial Arts is a physical activity and learning self-defense skills involves some physical contact. Gracie Gym and/or its staff and students are not to be held liable for any risks and/or injuries as a result of training Martial Arts. I have read and agree to this waiver of liability Full Name of Parent/Guardian or Student 18 years and older * Date * Thank you very much for submitting the this Waiver.
