Health Background

I, the undersigned do hereby submit my application for attendance and participation, and do hereby assume full responsibility for any and all damages, injuries, and/or losses that I or my child may sustain or incur, if any, while attending or participating, and I hereby agree to waive any and all claims against Maui Kajukenbo LLC, Kajukenbo Self-Defense Institute, Inc., its instructors, representatives, promoters, operators, sponsors and its agent, individually or otherwise, for any damages, injuries, losses, and/or death arising from or received during practice, regularly scheduled classes, or contests.

Must be 18 or over to sign