IMPORTANT! READ CAREFULLY! THIS RELEASE GIVES UP ANY RIGHT THAT YOU, YOUR SURVIVORS, OR REPRESENTATIVES MAY HAVE TO MAKE A LEGAL CLAIM OR SUE IF YOU ARE INJURED OR DIE BECAUSE OF YOUR PARTICIPATION IN THE EVENT!

Liability Waiver

The below named participant agrees to abide by all the rules set forth and accepted by Justin Surrency and FastKicks Academy.   I agree to abide by any decisions of Justin Surrency, FastKicks Academy, its instructors, employees, or agents regarding my ability to participate.  I understand and appreciate the risk; this activity involves risks and danger of serious bodily injury, including permanent disability, paralysis and death.  Risk also including, but not limited to, physical contact with others and with objects used in training pads, and falling, all of which may result in injury.  In consideration of the entities acting or entitled to act on my behalf, including my representatives, guardians, heirs and assigns, hereby releases Justin Surrency and FastKicks Academy,  its instructors employees, or agents from any and all claim, damages, liabilities and cause of action of any kind, and hereby voluntarily and knowingly waived any such claim, damages, liabilities and cause of action, and all rights hereto for any injury received while participating in this event. Further, I understand and acknowledge that I am solely responsible for my own medical benefits or health insurance to me or on behalf for any injuries I may suffer as a result of participating in class or any other activity on any premises owned, leased, or used by those persons or entities for this event.  Further I understand that photographs and video tapes may be taken of me in connection with my participation in these activities and I grant full usage of my image and likeness for promotional, publicity and advertising purposes connected with Justin Surrency and FastKicks Academy, without any present or future claim for compensation or damages.  I also covenant not to sue Justin Surrency, FastKicks Academy and/or its instructors, employees, or agents.  I further give consent to the medical staff provided at the event to give first aid care and advice should it be needed.   Permission to participate in this event sponsored Justin Surrency and FastKicks Academy is conditional upon completion of this form in full and acceptance of all terms and conditions stated herein, and evidence by my signature or that of my parents, as appropriate, affixed to this form in proper space below.