Waiver for Daniel Gracie Mainline/JADE Studio LLC

For the instruction/training session(s) instructed by Jason Santiago, their assigned instructors and/or assistants on the premises at 12 E Lancaster Avenue, Paoli, PA 19301 and/or 1207 County Line Road, Bryn Mawr, PA 19010, or on any premises where instruction is being conducted, I agree by my signature herein to indemnify and hold harmless Jason Santiago, Daniel Gracie Mainline, JADE Studio LLC, Main Line Martial Arts, the owner(s) and lessor(s) of the building, other participants of activities involving the aforementioned entities, and any agents, assigns, successors and heirs of Jason Santiago. I fully understand and agree that the practice/training of any martial arts and/or fitness/physical activity is potentially dangerous, including risk of illness, sickness, bodily harm or injury of varying severity up to and including death.

My agreement is to indemnify and hold harmless against all present or future causes of action, suits, claims and demands resulting from personal injuries, illness, death or personal property. 

I also understand mine or my child/dependents likeness may be used in print or video advertising media.

By submitting this form online and/or printing and submitting it in person, I acknowledge that my electronic signature and all fields below constitutes my agreement to the waiver terms. This is a binding signature and acknowledges my consent to the above stated terms of the waiver, whether electronically submitted or submitted through physical means.