First Name: Last Name:
Street:
City: State: Zip: Country:
Phone # : E-Mail:

Registration Info
Are you registering for the Combatant, On Track, or Fight Director level? :
Years of experience with combat for stage and screen? :
What weapons have you trained in and how long? :
Who are your previous instructors in combat for stage and screen? :
If you have a website please put the link here :
Professional organization memberships? :
Are you a member of AoC? :
How did you hear about the workshop?:

Medical History
Are there any Medical conditions we should be aware of? :
Do you take any Medications we should be aware of? :
Are you allergic to anything? :
Have you had any recent injuries? :
Emergency Contact Name:
Emergency Contact Number :
 

The Waiver and Release of Liability

I intend and do hereby agree to be legally bound for myself and for all successors in interest I may have, by this Waiver and Release of Liability, and hereby agree to hold harmless and indemnify the Access Theatre, Art of Combat inc., Jared Kirby, John Lennox as well as any coordinators, instructors, officers, members, employees, assistants, volunteers, assigns, or agents of any type whatsoever acting on or in behalf of the aforementioned entities and persons against any claims for damages or other claims for injuries or losses of any kind suffered by me or any others directly or indirectly arising out of any practice, instructions, or other activity related to this program as well as participation in this program or traveling to or from this program or any other activity related to this program.
I understand that this seminar reflects a study of weapon and grappling arts for the purposes of cultural heritage, artistic endeavors and recreation, and that the instructors in no way advocate that I should seek confrontations, directly or indirectly.  I further understand that the instructors are merely teaching techniques of martial arts systems and are in no way advocating physical violence towards another person. I hereby waive the Access Theatre, Art of Combat inc., Jared Kirby, John Lennox, as well as any coordinators, officers, members, employees, assistants, volunteers, assigns, or agents of any type whatsoever acting on or in behalf of the aforementioned entities and persons, of any liability for my actions; including, but not limited to: injury to myself or others and/or any property damage(s) resulting from any attempts by me to perform any of the techniques discussed, demonstrated or taught during this workshop by the aforementioned agents.
I understand that the nature of these activities may require close and intimate physical contact with other participants and/or instructors. I understand that this physical contact is necessary and inherent in the context and education of the material. I understand that the scenarios and topics to be discussed are mature and sensitive issues. I acknowledge and understand that it is my right to decline participation in any event with which I feel uncomfortable or unsafe, that it is my right to vocalize my feelings concerning the training, and that at any time I may choose to immediately cease activity or involvement. I further understand that if I require counsel with one or more of the instructors or other personnel that they are open and approachable.
I understand that any and all decisions are made in consideration of my personal safety and the safety of others, and that all decisions made by the Access Theatre, Art of Combat inc., Jared Kirby, John Lennox, as well as any coordinators, officers, members, employees, assistants, volunteers, assigns, or agents of any type whatsoever acting on or in behalf of the aforementioned entities and persons, are done so irrespective of race, creed, color, nationality, affiliation, gender, or sexual orientation.

Risks of Injury
I understand that some of the exercises and training methods to be taught involve the application of pain compliance and, if I choose to participate, will require me to submit to various types of physical restraint and exercise which may, in the course of demonstration and/or application cause me pain or injury. I understand that I may choose not to participate or stop my participation in any of these activities. I further understand that many of the exercises and training methods to be taught will require me to be in good physical condition. I certify that I am physically able to participate in this activity and will further hold the Access Theatre, Art of Combat inc., Jared Kirby, John Lennox, as well as any coordinators, officers, members, employees, assistants, volunteers, assigns, or agents of any type whatsoever acting on or in behalf of the aforementioned entities and persons, harmless for any injury sustained in the course of this training due to any physical defect or condition that I may have, whether now known or hereinafter discovered. I further acknowledge that in consideration for this training, this release shall not expire and shall be considered effective in perpetuity.
I also understand that the instructors will be teaching their classes in the safest possible atmosphere, however, as with any athletic activity, I am aware that participating in the Art of Combat Fight Directing Workshop can be dangerous, involving the risk of injury, including, but not limited to: bruises, cuts, partial or full paralysis, muscle tears, sprains and strains, broken bones, eye injury, head injuries, death, and/or other impairments to body or mind. I acknowledge that the risk and type(s) of injuries will vary with the activities in which I choose to participate.  Consequently, I agree:
To accept any and all risks involved with the activities in which I choose to participate.
To obey the instructors, and their agents to help minimize the risk of injury to myself and others.
To authorize Jared Kirby and/or John Lennox to admit me for medical treatment in an emergency.
That failure on my part to abide by the rules of the instructors will jeopardize my eligibility to participate in the event, and that the event coordinators reserve the right to remove me without reimbursement at their discretion if they feel that I am acting in an unsafe, or abusive manner.

Payment of Injury Expenses
I understand that the Access Theatre, Art of Combat inc., Jared Kirby, John Lennox, as well as any coordinators, officers, members, employees, assistants, volunteers, assigns, or agents of any type whatsoever acting on or in behalf of the aforementioned entities and persons, do not maintain medical insurance for any injuries resulting from this workshop, including any injuries sustained while en route to or from this workshop. It is my responsibility to provide medical insurance or other financial means of paying for any and all activity-related injuries.

Non-Refund Policy
I understand that the Art of Combat Fight Directing Workshop can not offer refunds of any kind. I hereby agree to hold harmless and indemnify the Access Theatre, Art of Combat inc., Jared Kirby, John Lennox, as well as any coordinators, officers, members, employees, assistants, volunteers, assigns, or agents of any type whatsoever acting on or in behalf of the aforementioned entities and persons.

I have understood all that is expressed above in this waiver and release of liability, and I certify that I am of sound judgment and legally competent to agree to this waiver. Additionally, I certify that I am eighteen years of age or older, or a legally emancipated adult. I understand that typing my name in the Waiver Release box constitutes my digital signature and holds the same weight as my written signature:

 

Appearance Release Form
For good and valuable consideration, receipt of which is hereby acknowledged, I authorize the Art of Combat Fight Directing Workshop (hereafter referred to as “AoC FD Workshop ”), Art of Combat (herafter referred to as “AoC), Jared Kirby, John Lennox, Shirley Chung and their respective parents, affiliates, subsidiaries, licensees, successors and assigns to make use of my appearance.

I agree that you may tape and photograph me, and record my voice, conversation and sounds, including any performance of any musical compositions(s), during and in connection with my appearance and that you shall be the exclusive owner of the results and proceeds of such taping, photography and recording with the right, throughout the world, an unlimited number of times in perpetuity, to copyright, to use and to license others to use, in any manner, all or any portion thereof or of a reproduction.

I further agree that you may use and license others to use my name, voice, likeness and any biographical material concerning me which I may provide, in any and all media and in the promotion, advertising, sale and publicizing of products in connection with AoC FD Workshop, AoC, Jared Kirby, John Lennox, Shirley Chung or its affiliated services, throughout the world in all media, and unlimited number of times in perpetuity.  I further represent that any statements made by me during my appearance are true, to the best of my knowledge, and that neither they nor my appearance will violate or infringe upon the rights of any third party.

I hereby release the AoC FD Workshop, AoC, Jared Kirby, John Lennox, Shirley Chung and their respective parents, affiliates, subsidiaries, licensees, successors and assigns from all liability, claims and obligations to me of any and all nature whatsoever arising out of or in connection with the exercise of the rights granted herein, including, without limitation, from any liability for libel, defamation, personal injury, violation of my rights of privacy, publicity, copyright, trademark or any other personal and/or property rights (“Claims”) and agree that I will not now or in the future assert or maintain any Claims against the AoC FD Workshop, AoC, Jared Kirby, John Lennox, Shirley Chung and their respective parents, affiliates, subsidiaries, licensees, successors and assigns .
                                                
I hereby waive any right of inspection or approval of my appearance or the uses to which such appearance may be put.  I acknowledge that you will rely on this permission potentially, at substantial cost to you and hereby agree not to assert any claim of any nature whatsoever against anyone relating to the exercise of the permissions granted hereunder.

I understand that typing my name in the Appearance Release box constitutes my digital signature and holds the same weight as my written signature: