Application and

Release of Liability

BEFORE YOUR FIRST LESSON PLEASE READ AND COMPLETE THIS APPLICATION/WAIVER. YOU MUST AGREE TO THE TERMS AND CONDITIONS AND SUBMIT THIS FORM TO BE ELIGIBLE FOR TRAINING WITH SIFU MILLS AND THE CHINESE BOXING INSTITUTE INTERNATIONAL GAINESVILLE, FLORIDA.
(This only needs to be done once and must be received prior to beginning your training.)

 
 

I am voluntarily participating in lessons, classes or activities with Sifu Ken Mills and the Chinese Boxing Institute International Gainesville, Florida. I understand that these lessons, classes or activities may require physical exertion that may be strenuous at times and may cause physical injury and I am fully aware of the risks and hazards involved in the participation and practice thereof.

I understand that it is my responsibility to consult with a physician prior to participation in these lessons, classes or activities. I represent and warrant that I have no medical condition that would prevent my participation.

I acknowledge and agree that Sifu Ken Mills and the Chinese Boxing Institute International has made no representation warranting my safety while participating in any lessons, classes or activities. I agree to assume full responsibility for any and all risks, injuries or damages, known or unknown, which I might incur as a result of my participation in these lessons, classes or activities and the practice thereof.

In consideration for my being allowed to participate, I knowingly, voluntarily and expressly waive any claim I may have against Sifu Ken Mills, the Chinese Boxing Institute International, its affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, from any and all actions, causes of action, damages, claims or demands of any kind that I, my heirs, executors, administrators or assigns may have for any and all injuries, damages, or losses of any kind, known or unknown, regardless of severity, which I may sustain while participating in lessons, classes or activities with Sifu Ken Mills and the Chinese Boxing Institute International Gainesville, Florida including the practice or use thereof any techniques or exercises taught.

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Acceptance for training with Sifu Mills and the Chinese Boxing Institute International Gainesville, Florida is contingent upon receipt of this checked and signed application and release of liability form.

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Name
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Phone
Address *
Address
Emergency Contact *
Emergency Contact
Emergency Contact Phone *
Emergency Contact Phone