New York Combat for Stage & Screen Waiver

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New York Combat for Stage & Screen Waiver

Participants (or a parent/guardian if participant is under 18) must fill out the form below prior to participation in NYCSS Classes, Seminars and Events

Email *

Participant Name *

Name of Parent or Guardian (If participant is under the age of 18)

Today's Date

YYYY

Phone Number *

Waiver and Release of Liability, Assumption of Risk and Indemnity Agreement

I intend and do hereby agree to be legally bound for myself and for all successors in interest I may have, by this Waiver and Release of Liability, and hereby agree to hold harmless and indemnify New York Combat for Stage & Screen (hereafter referred to as “NYCSS”) and Jared Kirby as well as any coordinators, instructors, officers, members, employees, assistants, volunteers, assigns, or agents of any type whatsoever acting on or in behalf of the aforementioned entities and persons against any claims for damages or other claims for injuries or losses of any kind suffered by me or any others directly or indirectly arising out of any practice, instructions, or other activity related to this class as well as participation in this class or traveling to or from this class.

I assume all of the risks associated with participating in this class, seminar, event or activity. This includes any risks that may arise inclusive of negligence, defective equipment or any property owned by NYCSS or because of their possible liability without fault. I understand that participation involves risks and dangers which include, without limitation, the potential for serious bodily injury, permanent disability, paralysis and loss of life. I understand these risks may be caused by my own actions or inactions, the actions or inactions of others participating or actions/inactions of the released parties. I hereby expressly assume all risks and responsibility I incur as a result of my participation.

I certify that I am physically fit, in good health, in proper physical condition and that there are no health related reasons that would preclude my participation. I have not been advised to not participate by a qualified medical professional. I agree that it is my sole responsibility to determine that I am able to participate.

I agree to be familiar with and to abide by all rules and regulations established by NYCSS for participation. I accept sole responsibility for my own conduct and actions while participating.

Appearance Release Form

For good and valuable consideration, receipt of which is hereby acknowledged, I authorize NYCSS, Jared Kirby and their respective parents, affiliates, subsidiaries, licensees, successors and assigns to make use of my appearance. I agree that you may tape and photograph me, and record my voice, conversation and sounds during and in connection with my appearance in class or training session. You shall be the exclusive owner of the results and proceeds of such taping, photography and recording with the right to use in any manner, all or any portion thereof.
I further agree that you may use my name, voice and likeness in any and all media in the promotion, advertising, and publicizing in connection with NYCSS, Jared Kirby or affiliated services and release the NYCSS, Jared Kirby and their respective parents, affiliates, subsidiaries, licensees, successors and assigns from all liability, claims and obligations to me in connection with the exercise of the rights granted herein. I hereby waive any right of inspection or approval of my appearance or the uses to which such appearance may be put.

Notice of Agreement

Do not sign this agreement unless you have read it in its entirety. Seek the advice of legal counsel if you are unsure of it's effect.

I have understood all that is expressed above in and certify that I am of sound judgment and legally competent to agree to this waiver. I warrant that I have read this Agreement carefully, that I understand its terms and conditions and acknowledge the legal rights I am giving up by signing it.

This agreement represents the complete understanding regarding these issues. If any provision is held to be unlawful, void or unenforceable, then that provision shall be deemed severable and shall not affect the validity and enforceability of any remaining provisions.

I have signed this agreement freely and voluntarily and intend for my signature to serve as confirmation of my complete and unconditional acceptance of the terms, conditions and provisions of this agreement. I certify that I am eighteen years of age or older, or a legally emancipated adult.

Do you agree to the above terms *

Yes

A copy of your responses will be emailed to the address you provided.

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