Liability Waiver Form
To the best of my knowledge, I am in good physical condition and fully able to participate in this
course. I am fully aware of the risks and hazards connected with the participation in Submission Wrestling, Muay Thai Kickboxing, Bootcamp Training, Weightlifting, or
Aerobics, including physical injury or even death, and herby elect to voluntarily participate in
said event, knowing that the associated physical activity may be hazardous to me and my
property. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OR
LOSS, PROPERTY DAMAGE, OR PERSONAL INJURY, INCLUDING DEATH, that may
be sustained by me, or loss or damage to property owned by me, as a result of participation in this
course. I further certify that I am at least 18 years of age. If under 18, my parent/guardian is the
below signed.
I hereby RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE, Four Pillars Combatives, Mark Blakeney, their officers, servants, agents, and employees (hereinafter
referred to as RELEASEES) from any and all liability, claims, demands, actions and causes of
action whatsoever arising out of or related to any loss, damage, or injury, including death, that
may be sustained by me, or to any property belonging to me, while participating in physical
activity, or while on or upon the premises where the event is being conducted.
It is my expressed intent that this release and hold harmless agreement shall bind the
members of my family and spouse, if I am alive, and my heirs, assigns and personal
representative, if I am deceased, and shall be deemed as a RELEASE, WAIVE,
DISCHARGE, and CONVENTION TO SUE the above named RELEASEES. I hereby
further agree that this Waiver of Liability and Hold Harmless Agreement shall be constructed in
accordance with the laws of the State of Mississippi.
In signing this release, I acknowledge and represent that I HAVE READ THE
FOREGOING Waiver of Liability and Hold Harmless Agreement, UNDERSTAND IT
AND SIGN IT VOLUNTARILY as my own free act and deed; no oral representations,
statements or inducements, apart from the foregoing written agreements have been made; and I
EXECUTE THIS RELEASE FOR FULL, ADEQUATE AND COMPLETE
CONSIDERATION FULLY INTENDING TO BE BOUND BY SAME.
