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It is understood that the training, instructions, testings, and/or lessons which I have herein before registered for and agreed upon, involve STRENUOUS PHYSICAL ACTIVITY, AND MAY RESULT IN PERSONAL INJURY.  The aforementioned party, whose signature is also hereinafter affixed, hereby avers and represents that he or she has no knowledge of any physical condition which would render it dangerous and/or hazardous to said party's health or safety for him or her to participate in such training, instructions, and/or lessons and PROMISES TO NOTIFY AMKOR KARATE OF COATESVILLE, INC., COATESVILLE, PENNSYLVANIA, ITS AGENTS AND/OR INSTRUCTORS, IMMEDIATELY, IN WRITING SHOULD ANY SUCH CONDITION DEVELOP.  It is understood that this written notification of such physical conditions shall be delivered, in person, to the Instructor (s) at Amkor Karate of Coatesville, Inc. Coatesville, Pennsylvania before the next lesson or workout which follows discovery and/or awareness by the undersigned of any change in his or her physical condition.  Upon receipt of such notification, the instructor (s) reserve the right to terminate and/or discontinue and/or postpone further lessons or workouts for said individual.

Recognizing, and being fully aware of all the facts, assertions, and representations, herein before mentioned, the party whose signature is affixed below, individually and for his heirs, executors, administrators, successors, and/or assigns EXPRESSLY ASSUMES ALL RISK OF INJURY RESULTING DIRECTLY OR INDIRECTLY FROM THE TRAINING, INSTRUCTIONS, TESTINGS, AND OR LESSONS IN KARATE, TAIJI (TAI CHI), OR OTHER PROGRAMS received at Amkor Karate of Coatesville, Inc. and/or affiliated classes, schools, and events which said party may enter.

It is expressly acknowledged and understood that  Amkor Karate of Coatesville, Inc. cannot consistently monitor or confirm its students' possession and use of mouth guards and suggested protective equipment. Accordingly, in addition to the express assumption of risk set forth above, and in no way limiting the scope or applicability thereof, it is specifically acknowledged and agreed by the party whose signature is affixed below that they, and/or their parents or guardians, shall bear full and exclusive responsibility for the purchase and use of a mouth guard and recommended protective equipment during all classes which they attend. If, at any time, said party fails to use a mouth guard or recommended protective equipment during the course of instruction, it is expressly agreed that neither Amkor Karate of Coatesville, Inc. nor any of its students or instructors, shall bear any responsibility or incur any liability whatsoever for any injury that may arise from such non-use.

Moreover, in consideration of receiving training, instructions, and/or lessons, at/by Amkor Karate of Coatesville, Inc. said party, whose signature is affixed below, individually and for his heirs, executors, administrators, successors, and/or assigns, does hereby waive, release, and forever discharge any and all rights and claims for any damages or losses which said party may have, or which may accrue to said party against Amkor Karate of Coatesville, Inc. and/or its instructors, officers, agents, representatives, successors, affiliated schools, facilities used for testings, and/or assigns, and against its students, for any and all causes which may arise in connection with the training, instructions, testings, and/or lessons in Karate, Taiji (Tai Chi), or other programs received at Amkor Karate of Coatesville, Inc.

I DO SOLEMNLY SWEAR, OR AFFIRM,

that I have truthfully and accurately completed all parts of this form and that I do fully understand the above Agreement and Release and will fully abide by its terms.