TWO-PART FORM FOR COMPLETION: COMPLETE & SUBMIT PDE STUDENT PROFILE. RETURN TO PAGE AND COMPLETE & SUBMIT WAIVER

PDE Student Profile and Indemnity Contract

Student/Participant's Name

First Name

Last Name

Phone

(###)

###

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Date of Birth

YYYY

Membership/Training Plan

Choose which membership/training plan you want to purchase. OR Seminar / Tournament Indemnity Only

Derobio Legacy L.L.C - Pulahan-Derobio Eskrima Practitioner: Hold Harmless and Indemnity Contract ... As a condition of acceptance into the Derobio Legacy L.L.C, the undersigned hereby declared:

1. I agree that I am responsible for and will indemnify and hold the Derobio Legacy L.L.C - Pulahan-Derobio Eskrima , and all its instructors, harmless from all claims and demands for damage, personal injury, or death, due to my participation in the activities associated with the Derobio Legacy L.L.C - Pulahan-Derobio Eskrima. This includes but is not limited to all forms of the Derobio Legacy L.L.C - Pulahan-Derobio Eskrima activities including before, during or after classes, and includes all public demonstrations.

2. I also agree that I am responsible for and will indemnify and hold the Derobio Legacy L.L.C - Pulahan-Derobio Eskrima, and all its instructors, harmless from all claims and demands for damage, personal injury, or death, due to my use of the Derobio Legacy L.L.C - Pulahan-Derobio Eskrima, as well as by my family, guests, and employees.

3. I have been informed that I should use protective gear while competing at the Derobio Legacy L.L.C - Pulahan-Derobio Eskrima. If I do not use protective gear while competing, I accept total responsibility for my actions, and will indemnify and hold the Derobio Legacy L.L.C - Pulahan-Derobio Eskrima, and all of its instructors, harmless from all claims and demands for damage, personal injury, or death.

4. I agree to do all of the above regardless of cause, even if the Derobio Legacy L.L.C - Pulahan-Derobio Eskrima or its instructors are deemed to have been negligent, in any manner.

5. I further agree that this Indemnity Contract will be binding on and for the benefit of me, the Derobio Legacy L.L.C - Pulahan-Derobio Eskrima, and my legal representatives, successors, and assigns.

6. I agree that this contract shall be enforceable to the greatest extent permitted by law. If it is unenforceable in any part, it will not be void in other parts where lawfully enforced.

Student Electronic Signature: Read this carefully, "by typing your Full Name (First and Last) you assume substantial personal liability."

Date Signed

YYYY

Parent / Guardian Electronic Signature

* IF PRACTITIONER IS UNDER 18 YEARS OF AGE, PARENTS/GUARDIANS SIGNATURE IS REQUIRED. Type Full Name ( First and Last)

ASSUMPTION OF RISK / WAIVER OF LIABILITY / INDEMNIFICATION AGREEMENT

In consideration of being allowed to participate on behalf of Derobio Legacy L.L.C - Pulahan-Derobio Eskrima martial arts program and related events and activities, the undersigned acknowledges, appreciates, and agrees that:

Participation includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and, I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases. If, however, I observe any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and, I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Derobio Legacy L.L.C - Pulahan-Derobio Eskrima, their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

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

Name

First Name

Last Name

Student Electronic Signature: Read this carefully, "by typing your Full Name ( First and Last) you assume substantial personal liability."

Date Signed

YYYY

FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF REGISTRATION) This is to certify that I, as parent/guardian, with legal responsibility for this participant, have read and explained the provisions in this waiver/release to my child/ward including the risks of presence and participation and his/her personal responsibilities for adhering to the rules and regulations for protection against communicable diseases. Furthermore, my child/ward understands and accepts these risks and responsibilities. I for myself, my spouse, and child/ward do consent and agree to his/her release provided above for all the Releasees and myself, my spouse, and child/ward do release and agree to indemnify and hold harmless the Releasees for any and all liabilities incident to my minor child’s/ward’s presence or participation in these activities as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent provided by law.

Parent/Guardian's Name

First Name

Last Name

Parent/Guardian Electronic Signature: Read this carefully, "by typing your Full Name ( First and Last) you assume substantial personal liability."

Date Signed

YYYY