Women's Self Defense: Saturday, January 6, 2018, 9-12pm
I am requesting a lesson/lessons in Ving Tsun Kung Fu at the Moy Yat Kung Fu Academy. I understand this requires some physical contact between myself and instructors as well as other students, and consent to contact required by training.

I voluntarily assume all risks of injury that may be sustained in the participation of lessons and in demonstrations of techniques, whether on-site or off-site, in association with Moy Yat Kung Fu Academy. I will not hold Moy Yat Kung Fu Academy or their employees liable for any injury not caused by their negligence; if I request any technique to be demonstrated on me while I resist, in order to "test the Kung Fu", I will not hold Moy Yat Kung Fu Academy or their staff liable for any injury I sustain as a result.

I grant permission to Moy Yat Kung Fu Academy, and Moy Yat Family Kung Fu Association to photograph my image, likeness, or depiction and/or that of my minor children (if applicable) to be used for educational and advertisement purposes, and in any medium, including print and electronic.

I will not teach any of the forms, techniques, teaching methods, or concepts I learn from the Moy Yat Kung Fu Academy before I receive written certification from the Moy Yat Kung Fu Academy.

I hereby release and agree to not hold Moy Yat Kung Fu Academy, its owners and instructors, liable to claims of any injury or damage I sustain as a result of participation of lessons and demonstrations in association with the school.

I will not use any of the techniques I learn in a way that could endanger or harm another person, except to protect myself and my loved ones, or in accordance with the rules of any tournament I may enter.

Sending this form means that Client has read, understands, and agrees to all terms and conditions set forth in this document.


****For groups, please make sure every person has a separate form filled out.

Thank you!

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