Waiver of Liability & Agreement

Participant's Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Email

example@example.com

Emergency Contact Person

First NameLast Name

Emergency Contact Phone

Area CodePhone Number

GENERAL

I hereby acknowledge and agree to the following as a condition of participation in this Self Defense seminar/training. I give permission to FoxyDefensePro for images, through photo and video, to be used.

1. My involvement and/or participation in this seminar/training is voluntary.

2. I understand that there is a risk of danger, bodily harm, injury, emotional stress, or death as a result of my participation. I also understand that not all the risks and potential risks arising from Self Defense tactics and movements are limited to this list (striking, sparing, swinging, and kicking). There is a potential for risks and dangers that may not be obvious or reasonable foreseeable at this time.

3. I do not have any medical aliments, injuries, physical limitations, or mental disabilities that will affect my ability to participate in this Self Defense seminar/training.

4. I understand this Self Defense seminar/training has been designed to provide me with the safest and most effective way to survive and escape a physical assault. However, I understand that the instructors cannot guarantee my safety through the use, or misuse, of the techniques taught.

5. I forever release Foxy Defense and Protection, LLC, it’s instructors, all participants, Demetra Bradley, and the host facility, from direct legal or financial responsibility regarding any and all claims and causes of action that I now or may have in the future for personal injury, personal safety and well-being, property damage, or wrongful death occurring to me, arising out of participation in this Self Defense seminar/training.

6. I am 100% liable for all medical expenses incurred as a result of any injury or property damage during my participation. FoxyDefensePro may, but has no obligation, to provide medical attention.

7. In the event that any one or more of the provisions of this agreement shall be held to be invalid, illegal, and enforceable or in conflict with the law according to this jurisdiction, of the State of Texas, the remaining portions will not be invalidated, and shall remain in full effect. This is a legally binding contract, but it is not meant to pronounce any claims or defenses that are legally prohibited.

I have read and understand this document, and agree to all provisions listed above.

COVID HEALTH SCREENING

1. I, nor members of my household, have not experienced and COVID-19 symptoms (fever, fatigue, dry cough, difficulty breathing) within the last 14 days.

2. I, nor members of my household, have not traveled internationally in the last 30 days.

3. I, nor members of my household, have not traveled to a highly impacted area within the USA in the last 30 days.

4. I, nor members of my household, do not believe that we have been exposed to someone suspected and/or confirmed to have COVID-19.

5. I, nor members of my household, have not been diagnosed with COVID-19 within the last 30 days.

6. Demetra or FoxyDefensePro can not be held liable from any exposure to COVID-19 caused by misinformation on this form or the health history provided by each participant.

I agree that my answers are truthful, and I understand these questions are to help protect myself and others in attendance.

Date

Electronic Signature