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  • Poolesville Self Defense Training Session Questionnaire, Fitness Release and Waiver of Liability

    Please Complete the Information Below
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  • MEDICAL HISTORY (Complete at your discretion. We will not share your information with anyone)

  • PERSONAL DETAILS

  • If you have answered YES to any of the above questions, you must obtain a medical clearance prior to carrying out a physical exercise program.

  • RELEASE and LIABILITY WAIVER

    Please read carefully before submitting form.

  • Release: We, the student and guarantor, if applicable, on behalf of ourselves, members of our family, our heirs, executors, administrators, and assigns, hereby forever release, discharge, and hold harmless, Poolesville Self Defense LLC, RPC Fitness LLC, Mark Munster and Ray Castro, their families, or any representatives or agents, Fishpool LLC., the property owner/landlord for any injury, loss, or damage to my person or property howsoever caused, arising out of or in connection with my taking part in personal training sessions or martial arts classes, seminars and activities and notwithstanding that the same may have been contributed to or occasioned by the negligence of Poolesville Self Defense LLC, RPC Fitness LLC, Mark Munster, Ray Castro, their families, or any representatives or agents, Fishpool LLC or the property owner/landlord. Please note participant must supply their own protective equipment.

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