SAFETY WAIVER AGREEMENT

(A) CUSTOMER / LEGAL GUARDIAN INFORMATION ONLY - TO BE FILLED OUT BY APPLICANT
(PLEASE PRINT CLEARLY)

WAIVER AND RELEASE OF LIABILITY: Lane Academy of Martial Arts from here on out will be referred to as the School. The School urges you and all students to obtain a physical examination from a doctor before using any exercise equipment or participating in any exercise class. All exercises, including the use of weights and use of any and all machinery, equipment, and apparatus designed for exercising shall be at the student's sole risk. Student understands that the agreement to use, or selection of exercise programs, methods and types of equipment shall be student's entire responsibility, and the School shall not be liable to student for any claims, demands, injuries, damages, or actions arising due to injury to student's person or property arising out of or in connection with the use by student of the services, facilities, and premises of the School. Student hereby holds the School, its officers, owners, agents and employees harmless from all claims which may be brought against them by student or on student's behalf for any such injuries or claims.

NOTICE: STUDENT AGREES THAT THE USE OF ALL FACILITIES WILL BE AT STUDENT'S RISK. STUDENT WAIVES ANY CLAIMS FOR INJURY TO SELF OR FOR DAMAGE, LOSS OR THEFT OF STUDENT'S PROPERTY ARISING OUT OF OR IN CONNECTION WITH THE USE OF THE FACILITY (INCLUDING PARKING AREA), AND/OR OFF SITE EVENTS HELD BY THE SCHOOL. STUDENT ASSUMES ALL LIABILITY IN THE EVENT HIS/HER GUEST(S) OR ANY FAMILY MEMBER IS INJURED OR SUSTAINS ANY LOSS.