RAPE ESCAPE AND COMBATIVE TECHNIQUES

WAIVER

Please print the following form, complete, sign and bring to your first class:


Name ___________________________________________________________________

Address _________________________________________________________________

City ___________________________________ State __________ Zip __________

I understand the Rape Escape Course 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 in the class. Furthermore, I understand that all reasonable precautions are taken during class to provide a safe environment, but due to the very nature of contact inherent in practicing self-defense techniques, I hold harmless the instructors and the owners of the facility in which the class is held. I also give permission to use my image on video or film for promotional or instructional purposes.

Furthermore, you indemnify and hold R.E.A.C.T. Self Defense, LLC., its officers, employees and representatives free and harmless from any and all claims, liability, loss, damage, or expenses arising out of your participation in any training sessions or demonstrations put on by R.E.A.C.T. Self Defense, LLC.

Signed ________________________________________________

Date _______________________________

Yes, let me know about upcoming classes!

E-mail: ______________________________