All Students MUST complete this registration form and pay the one-time non-refundable $40.00 registration fee BEFORE attending any of our classes.
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PARTICIPATION RELEASE AND WAIVER
I ACKNOWLEDGE that the courses or seminars I am going to participate in with Polygon Elite, LLC, herein after collectively “PE,” involves a dangerous activity, as does any strenuous physical activity. I acknowledge that this training carries with it the potential for death, serious injury, property damage and property loss. I hereby assume all the risks for participating in any PE course or seminar. I promise to conduct myself in a safe and prudent manner, so as not to endanger myself or others. If my conduct, actions, or statements while participating in any PE course or seminar are determined to be detrimental to the safety or well being of other participants, the instructor or the public at large I shall willingly comply with the requests of the instructor or his agents to remove myself and my effects from the training site immediately. I realize and agree to the fact that I will forfeit any prepaid training fees if requested by the instructor to terminate my training.I HEREBY REPRESENT that I am in physical and mental good health to engage in strenuous physical activity and hereby acknowledge that the course or seminar will include, but is not limited to, fast motion, contact, punching, kicking, trapping, throwing, joint locking, intercepting, falling, rolling, training weapons, being shot with ballistic balls and/or paint balls, and self defense techniques, at times without protective gear, and is therefore an inherently dangerous and risky activity. I hereby execute this Waiver and Release form from Liability on behalf of myself, my personal representatives, my administrators, my heirs, my next of kin, my survivors, my successors and my assigns, as follows:A. I WAIVE, RELEASE, DISCLAIM and FOREVER DISCHARGE from any and all liability for me while participating in any PE course or seminar, the following entities or persons: Sergei Maslikhov, PE, Fighthouse, Westside Rifle and Pistol Range, Inc., and all other employees, volunteers, representatives, agents, assigns, funders, and sponsors, together with vendors and manufacturers, and their respective directors, officers, employees, representatives, agents, and assigns involved in any way with PE.B. I INDEMNIFY AND HOLD HARMLESS the entities and persons specified in paragraph A above from any and all liability, loss, demand, claim or action at law or in equity that may hereafter be made or brought by those individuals or entities as a result of any of my actions during any PE course or seminar. This indemnification and hold harmless agreement obligates me to defend my action brought against the entities and persons specified in paragraph A above as a result of any of my actions during a PE course or seminar. Should I refuse to undertake my responsibilities under this paragraph, I will be liable for attorneys fees and costs incurred by the entities and persons specified in paragraph A above in defending any action brought against them as a result of any of my actions or those of my family members during a PE course or seminar.
C. I CONSENT to receive medical treatment that may be deemed advisable as a result of any injuries I receive during a PE course or seminar, and agree that I am solely responsible for all costs, including diagnosis, treatment, medical transportation, and evacuation, that may become necessary for me or another person as a result of any of my actions during a PE course or seminar. I am aware that medical services or facilities may not be readily available or accessible during some of the time in which I am participating in a PE course or seminar.
D. I AGREE that any photographs and audio or video recordings taken of me during this PE course or seminar may be printed, reproduced and published in any manner anywhere without any further consent by me or my family members and without any compensation to me.
E. If any portion of this agreement should be determined by a Court to be null and void, the remaining portions of the agreement shall remain in full force.
F. I CERTIFY that I have read this document, understand its contents in their entirety and have executed this document below without reservation or duress.