Participation Agreement, Assumption of Risk, Release of Liability, and Medical Authorization

PLEASE READ CAREFULLY BEFORE SIGNING. THIS DOCUMENT AFFECTS YOUR LEGAL RIGHTS, INCLUDING YOUR RIGHT TO SUE FOR INJURIES.

Class Information

Class: Kickboxing / Self-Defense

Instructor: Ian Rosenkranz 

Location: Rainbow Baptist Church, 1571 FM 200, Rainbow, TX 76077

Day / Time: Tuesday, 3:00 p.m. – 3:55 p.m.

Nature of the Class

This is an instructional, non-combat class. Students learn kickboxing fundamentals and personal self-defense technique through drills, conditioning, footwork, pad and bag work, and controlled, cooperative partner practice under the instructor's direct supervision.

There is no sparring, no full-contact fighting, no competition, and no striking of another student's body. Any partner work is slow, cooperative, and instructor-directed.

The class is taught from a Christian framework emphasizing discipline, respect, self-control, perseverance, and the protection of others.

Acknowledgment and Assumption of Risk

I UNDERSTAND THAT PHYSICAL ACTIVITY OF THIS KIND INVOLVES INHERENT RISKS THAT CANNOT BE ELIMINATED REGARDLESS OF THE CARE TAKEN BY THE INSTRUCTOR OR THE CO-OP.

I understand these risks include, but are not limited to:

• Sprains, strains, muscle pulls, bruises, cuts, and abrasions
• Broken bones, dislocations, joint or ligament injury
• Impact from pads, bags, mats, flooring, walls, or equipment
• Accidental contact from another participant or the instructor during demonstration or practice
• Slips, trips, and falls
• Overexertion, dehydration, heat illness, fainting, or aggravation of an existing condition
• Head, neck, spinal, dental, or eye injury
• Cardiac or respiratory events
• Exposure to communicable illness
• In rare cases, permanent disability, paralysis, or death

I further understand these risks may result from my child's own actions or inaction, the actions or inaction of others, the condition of the facility or equipment, or the ordinary negligence of the Released Parties named below.

KNOWING AND UNDERSTANDING THESE RISKS, I VOLUNTARILY CHOOSE TO ENROLL MY CHILD IN THIS CLASS AND EXPRESSLY ASSUME ALL SUCH RISKS ON MY OWN BEHALF.

Student Conduct and Responsible Use of Skills

I have discussed the following with my child, and we both agree:

1. Skills taught in this class are for self-defense only. My child will use them only in the manner in which they are taught — in class, under instructor supervision, or in a genuine situation requiring lawful self-defense or the defense of another.
2. My child will never use these skills to bully, intimidate, threaten, retaliate, show off, or initiate physical contact with any person, at the co-op or anywhere else.
3. My child will follow all instructor directions, safety rules, and stopping commands immediately and without argument.
4. My child will not practice techniques on siblings, friends, or other students outside of supervised class time.
5. My child will treat classmates, partners, and the instructor with respect at all times.
6. My child will report any injury, pain, or discomfort to the instructor right away.
7. My child will wear appropriate athletic clothing and footwear and remove jewelry, watches, and hard accessories before class.

I understand and accept that I, as parent/guardian, am solely responsible for my child's use or misuse of these skills outside of supervised class instruction, and that the Instructor and the Co-op bear no responsibility for such conduct.

I understand that violation of this conduct standard may result in immediate removal from the class without refund.

Medical Treatment Authorization and Financial Responsibility

In the event of injury or illness, I authorize the Instructor and Co-op staff to administer basic first aid and, if I cannot be reached promptly, to secure and consent to medical care for my student, including evaluation, transport by ambulance, and treatment by a physician, urgent care, hospital, or emergency medical personnel.

I understand the Instructor and Co-op will attempt to reach me at the phone numbers above, and will call 911 without delay if the situation appears to warrant it.

I ACCEPT FULL FINANCIAL RESPONSIBILITY FOR ALL COSTS OF FIRST AID, AMBULANCE TRANSPORT, EVALUATION, AND TREATMENT ARISING FROM MY STUDENT'S PARTICIPATION. I UNDERSTAND THAT NEITHER THE CO-OP NOR THE INSTRUCTOR PROVIDES OR PAYS FOR MEDICAL, ACCIDENT, OR HEALTH INSURANCE FOR PARTICIPANTS, AND THAT ANY MEDICAL COSTS ARE BILLED TO ME AND MY OWN INSURANCE.

RELEASE OF LIABILITY, WAIVER OF CLAIMS, AND INDEMNIFICATION

"Released Parties" means Glen Rose Christian Co-op, its board, directors, officers, members, teachers, volunteers, employees, and agents; Ian Rosenkranz individually and any business entity through which he teaches; any assistant instructors; and the owner, lessor, and operator of the premises where the class is held.

IN CONSIDERATION OF MY CHILD BEING PERMITTED TO PARTICIPATE IN THIS CLASS, I, ON BEHALF OF MYSELF, MY SPOUSE, MY HEIRS, EXECUTORS, ADMINISTRATORS, AND ASSIGNS, HEREBY RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE THE RELEASED PARTIES FROM AND FOR ANY AND ALL CLAIMS, DEMANDS, ACTIONS, CAUSES OF ACTION, LIABILITIES, LOSSES, COSTS, MEDICAL EXPENSES, AND ATTORNEYS' FEES ARISING FROM OR RELATED TO ANY INJURY, ILLNESS, DEATH, OR PROPERTY DAMAGE SUSTAINED BY MY CHILD OR BY ME IN CONNECTION WITH THIS CLASS OR PRESENCE ON THE PREMISES.

I SPECIFICALLY INTEND THIS RELEASE TO COVER CLAIMS CAUSED IN WHOLE OR IN PART BY THE ORDINARY NEGLIGENCE OF THE RELEASED PARTIES, INCLUDING NEGLIGENT INSTRUCTION, NEGLIGENT SUPERVISION, NEGLIGENT SELECTION OR MAINTENANCE OF EQUIPMENT, AND NEGLIGENT CONDITION OF THE PREMISES.

INDEMNIFICATION. I agree to indemnify, defend, and hold harmless the Released Parties from any claim, loss, liability, judgment, cost, or attorneys' fee brought by or on behalf of my child, or brought by any third party, arising out of my child's participation in this class or my child's conduct, including any use of skills learned in this class.

LIMITATION. This release does not apply to gross negligence, willful or wanton misconduct, or intentional acts of the Released Parties, and does not waive any right that cannot be waived under Texas law.

Please read the entire agreement above before signing. You may download or print a copy of this agreement for your records at any time.