Self-Defense Workshop - Up Against a Wall Sunday, February 17, 2019 7:00 PM 9:00 PM 19:00 21:00 Hazo Household 304 Buffalo Ridge Road Canonsburg, PA, 15317 United States (map) Google Calendar ICS View fullsize Anna Hazo’s Self-Defense PartyWhat You’ll Learn:How to strike at close range so you can have maximum impact.How to escape from typical holds and grabs so that you can turn the tables.How to read your environment so you can use what's around you to your advantage.How to stay alert so that you have an escape route at all times.And much more!Registration Form: Name * First Name Last Name Email Address * Cell Phone (###) ### #### Liability Release/Training Agreement * PITTSBURGH COMBAT CLUB, LLC LIABILITY RELEASE FORM AND TRAINING AGREEMENT PERPETUAL PARTICIPANT AGREEMENT, RELEASE AND ASSUMPTION OF RISK This form must be agreed to by and for each participant. PLEASE READ CAREFULLY BEFORE SIGNING THERE ARE INHERENT RISKS OF INJURY WHILE PARTICIPATING IN THESE ACTIVITIES. SERIOUS INJURY MAY RESULT FROM YOUR PARTICIPATION IN THESE ACTIVITIES. NOTICE: READ THIS FORM COMPLETELY AND CAREFULLY In consideration of being allowed to use the facility and participate in the services, activities, and training opportunities provided including but not limited to martial arts instructional training and education (herein collectively referred to as “ACTIVITIES”) by Pittsburgh Combat Club, LLC, its agents, owners, officers, volunteers, participants, employees and all other persons or entities acting in any capacity of their behalf (herein collectively referred to as “PCC”), I, on behalf of myself and/or on behalf of my minor child(ren)/ward(s) hereby agree to, and do forever release, indemnify, hold harmless and discharge PCC, on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representatives and estate as follows: REPRESENTATION OF HEALTH : I hereby represent and acknowledge that (i) I am in good health and in proper physical and emotional condition to engage in ACTIVITIES, and (ii) I am not under the influence of alcohol or illicit or prescription drugs which would in any way impair my ability to safely participate in ACTIVITIES. I agree that it is my sole responsibility to determine whether I am sufficiently fit and healthy enough to participate in ACTIVITIES and I also acknowledge that PCC is under no obligation to require me to prove my degree of health or fitness. ACKNOWLEDGEMENT, UNDERSTANDING AND APPRECIATION OF THE RISKS. I hereby acknowledge that I understand that my participating in ACTIVITIES entails known and unanticipated risks that could result in death, serious physical or emotional injury, paralysis, or damage to me, to property or to third parties. I understand that such risks cannot be eliminated without jeopardizing the necessary qualities of the ACTIVITIES. These risks include, but are not limited to: vigorous physical movement on my own part, on the part of my training partners, and with other participants; with and without training equipment along with mental, physical, and spiritual techniques for integrating the mind and body. These risks also include bodily contact with training partners, others, and/or training equipment and will expose me to the risk of bodily injury. I give full consent to such contact and activity as I realize this is normal and realistic for combative martial arts training. I further acknowledge that by entering into this training, I will be exposed to a risk of physical injury arising out of possible negligence, unavoidable accident, or otherwise, due to the very nature of the self-protective defensive arts being taught including but not limited to sprains, fractures, scrapes, bruises and cuts, dislocations, pinched fingers and serious injuries to the head, back, or neck; injuries arising out of the negligence or otherwise caused by other participants or myself; injuries due to my own physical or mental condition or any medical condition I may have whether known or unknown, injuries due to physical contact with others, including the risk of contracting illness or coming into contact with viruses, bacteria, germs, or fungi whether by contact with equipment or with another participant, and any and all risks associated with exercise, physical exertion and physical activities (hereinafter collectively referred to as the “RISKS”). ASSUMPTION OF THE RISK. I knowingly and willingly assume all of the RISKS. My participating in ACTIVITIES at PCC is purely voluntary, and I elect to participate in spite of the RISKS. I hereby waive any and all claims that I or anyone else on my behalf may or could make with respect to such. I hereby acknowledge that I fully realize that during training, I always have the option at all times to withdraw from participation in any exercise, meditation, or technique, without comment and that it is my personal responsibility to decide which techniques I will participate in and are medically appropriate for me to participate in. YOU ARE AGREEING TO ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY OR TO LET YOUR MINOR CHILD(REN)/WARD(S) ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY. YOU ARE AGREEING THAT, EVEN IF PCC USES REASONABLE CARE IN PROVIDING THESE ACTIVITIES, THERE IS A CHANCE YOU OR YOUR CHILD(REN)/WARD(S) MAY BE SERIOUSLY INJURED OR KILLED BY PARTICIPATING IN THIS ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM, YOU ARE GIVING UP YOUR CHILD(REN)’S/WARD(S’) RIGHT AND YOUR RIGHT TO RECOVER FROM PCC IN A LAWSUIT FOR ANY DAMAGES, INCLUDING PERSONAL INJURY OR DEATH TO YOU OR YOUR CHILD(REN)/WARD(S), OR ANY PROPERTY DAMAGE, THAT RESULTS FROM THESE RISKS. YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM, AND PCC HAS THE RIGHT TO REFUSE TO LET YOU OR YOUR CHILD(REN)/WARD(S) PARTICIPATE IF YOU DO NOT SIGN THIS FORM. If, in my conduct, actions, or statements while participating in this training are determined to be inappropriate or detrimental to the safety or well-being of other participants or the instructors, I shall willingly comply with the request of the senior trainer to remove myself and my effects from the site of training immediately. I realize and agree to the fact that I forfeit any prepaid training fees if requested to terminate my training. RELEASE OF LIABILITY. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless PCC from any and all claims, demands, or causes of action, which are in any way connected with my, my spouse, or my child(ren)’s/ward’(s’) use of PCC’s equipment or facilities, including, to the extent permitted by law, any such claims which allege negligent acts or omissions of PCC. I understand that this perpetual release/waiver will apply to each and every occasion that I or my child(ren)/ward(s) visit a PCC facility. I understand that injuries may occur as a result of participation in the ACTIVITIES. Should emergency medical treatment be required, I, myself, and/or on behalf of my minor child(ren)/ward(s) agree that our own accident/medical insurance company shall be responsible for such incurred expenses. ATTORNEYS’ FEES, INSURANCE. Should PCC or anyone acting on its behalf, be required to incur attorneys’ fees and costs to enforce this agreement, including but not limited to, attorneys’ fees and costs incurred to defend against claims brought by me, or on behalf of my child(ren)/ ward(s), or by third parties, I agree to indemnify and hold PCC or anyone acting on its behalf harmless for all such fees and costs. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. By agreeing to this document, I understand that I may be found by a court of law to have forever waived my and my child(ren)/ward(s) right to maintain any action against PCC on the basis of any claim from which I have released PCC and any released party herein. I have had reasonable and sufficient opportunity to read and understand this entire document and consult with legal counsel, or have voluntarily waived my right to do so. I knowingly and voluntarily agree to be bound by all of the terms and conditions set forth herein. I represent that I have the actual authority to and do hereby enter into this agreement on behalf of, and as an authorized agent, parent or legal guardian of any child(ren)/ward(s) listed on this agreement. I have read and knowingly and voluntarily signed this agreement Release contained herein and further agree that no oral representations, statements or inducement have been made to me. I Agree Thank you!
