Release of Liability

This form must be completed before your first class, private training session, or seminar.

If you are under 18 years of age, a parent or guardian must complete the bottom portion.

Student/Participant Name

First Name

Last Name

Date of Birth

YYYY

In consideration of being permitted to participate in any way in the instruction and activities of self-defense/martial arts/Jujutsu, I acknowledge, appreciate, and agree that:

1.) The risk of injury from the activity involved in self-defense/martial arts/Jujutsu is significant, including the potential for permanent disability and death, and while particular protective equipment and personal discipline will minimize this risk, the risk of serious injury does exist;

2.) I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of those persons released from liability below, and assume full responsibility for my participation; and,

3.) I understand that the activities of self-defense/martial arts/Jujutsu are physically and mentally intense. I understand the rules and will comply with all rules and regulations. If I observe any unusual or unnecessary hazard during my participation, I will bring such to the attention of the nearest instructor or officer as soon as practical; and,

4.) I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release and hold harmless Logic Self-Defense LLC, Daniel Buckley, the family of Daniel Buckley, the owners and lessors of the premises used to conduct the self-defense instruction, their officers, officials, agents and/or employees ("Releasees"), with respect to any and all injury, disability, death, or loss or damage to person or property, whether caused by the negligence of the Releasees or otherwise, except that which is the result of gross negligence and/or wanton misconduct.

5.) I acknowledge the contagious nature of the COVID-19 virus, and respect that the facility adheres to the CDC recommendations of practicing social distancing and wearing face coverings when practical.

6.) I further acknowledge that Logic Self-Defense LLC has put in place preventative measures to reduce the spread of the COVID-19 virus, to the best of their abilities.

7.) I further acknowledge that no guarantee exists regarding whether or not I may contract COVID-19. I understand that the risk of becoming exposed to and/or infected by the COVID-19 virus may result from the actions, omissions, or negligence of myself and others, including, but not limited to, staff and other clients.

8.) I acknowledge that I increase my risk of exposure to COVID-19 by participating in services rendered. I acknowledge that I must comply with all set procedures to reduce the spread while in attendance.

9.) Each time that I enter the training facility or participate in a class, private training session, or seminar, I am attesting that:

A.) I am not experiencing any symptoms of illness such as cough, shortness of breath, difficulty breathing, fever, chills, muscle pain, headache, sore throat, or new loss of taste or smell.

B.) I have not traveled internationally within the last 14 days.

C.) I have not traveled to a highly impacted area within the United States in the last 14 days.

D.) I do not believe I have been exposed to someone with a suspected and/or confirmed case of COVID-19.

E.) I have not been diagnosed with Coronavirus/Covid-19 by state or local public health authorities.

F.) I am following all CDC recommended guidelines as much as possible, including limiting any purposeful exposure to COVID-19.

10.) I understand and agree that this Release of Liability agreement covers each and every class and event in which I participate hereafter.

I hereby release and agree to hold Logic Self-Defense LLC harmless from any causes of action, claims, demands, damages, costs, expenses and compensation for damage to myself that may be caused by any act, or failure to act, or that may otherwise arise in any way with any services received. I understand that this release discharges the aforementioned from any liability with respect to bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received. This liability waiver and release extends to Daniel Buckley, the family of Daniel Buckley, the owners and lessors of premises used to conduct the self-defense instruction, their officers, officials, agents and/or employees.

I have read this Release of Liability and assumption of risk agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without any inducement.

Student/Participant E-Signature

Type your name. Electronic signatures are enforceable under Ohio Revised Code Section 1306.06.

Student/Participant Email

Parental consent for students/participants under 18 years of age

This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree not only to his/her release of Logic Self-Defense LLC, Daniel Buckley, the family of Daniel Buckley, and all other Releasees, but also to release and indemnify the Releasees from any and all liabilities incident to his/her involvement in these programs for myself, my heirs, assigns, and next of kin.

Parent or Guardian E-Signature

Type your name. Electronic signatures are enforceable under Ohio Revised Code Section 1306.06.

Parent or Guardian Email