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{name}                {dob}

{address}            {phone}

{contact_name}  {contact_relation}  {contact_phone}

Agoge Combatives (Dynamas, LLC) urges you an all students, members, and guests to obtain a physical examination from a doctor before participating in any exercise class or using any training equipment.  As a member/participant of Agoge Combatives, I intend to and will engage in strenuous activities and classes on the premises of Agoge Combatives. I understand that these physical activities involve certain risk and exposure to personal injury, with risk and exposure. I voluntarily assume for myself and any member of my family, next of kin, including children who visit or participate in programs at Agoge Combatives. The undersigned member, guest, and/or guardian agrees, understands, and accepts responsibility for the physical risks, exercises, and participation, selection of any and all programs, seminars, and/or methods including the use of all equipment, apparatus and facility shall be undertaken at his/her sole risk. Agoge Combatives and Rigan Machado Association (RMA) including all officers, agents, directors, volunteers; all employees, independent contractors, and other guests or instructors of any of these organizations shall be RELEASED FROM LIABILITY, HELD HARMLESS, INDEMNIFIED, AND FOREVER NOT BE LIABLE for any injuries, disability, death, or any damage to him/her, or his/her property, or be subject to any claims, demands, injury, or damages whatsoever, including without any limitations, those damages resulting from acts of active or passive negligence on the part of Dynamas, LLC, Agoge Combatives, or RMA, it’s officers, agents, directors, volunteers, all employees, independent contractors, and other guests or instructors.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND IT’S TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND WITHOUT ANY INDUCEMENT.