This agreement is between the enrolled student and Prepare, Inc., and IMPACT International, its employees, contractors
and affiliated organizations (collectively referred to as IMPACT).
In consideration for enrollment in the IMPACT self defense course (the “Course”), I make the
following statements and promises:
I AM AWARE THAT THE COURSE INVOLVES STRENUOUS PHYSICAL ACTIVITIES AND PERSONAL BODY
CONTACT, AND THAT I WILL BE PARTICIPATING IN SIMULATED ASSAULT SCENARIOS WHICH CAN BE
PHYSICALLY HARMFUL AND/OR EMOTIONALLY STRESSFUL.
I AM VOLUNTARILY TAKING THE COURSE WITH KNOWLEDGE OF THE DANGER INVOLVED AND I AGREE TO ACCEPT
ANY AND ALL RISKS OF PHYSICAL AND PSYCHOLOGICAL INJURY.
IF I HAVE A DISABILITY, ILLNESS, OR I AM CURRENTLY SEEING A THERAPIST, I PROMISE TO CONSULT WITH MY
PHYSICIAN OR THERAPIST BEFORE TAKING THE COURSE.
I agree that I, my heirs, legal representatives and assigns: (1) will not make a claim or initiate suit
against IMPACT for any injury or damage resulting from my participation in the Course, and (2) will
release and discharge IMPACT from all claims or demands arising from injury or damage to me
caused by my participation in the Course.
I promise to defend, indemnify and hold IMPACT harmless from any claims and actions by third
parties alleging injury from my use of the techniques learned in the Course. I have not requested or
received any express warranties as to the effectiveness of the Course and IMPACT does not make any
implied warranties with regard to fitness or use of the instruction I am about to receive.
IF I AM PREGNANT, OR BECOME PREGNANT BEFORE COMPLETING THE COURSE, I WILL PROVIDE
WRITTEN CONSENT FROM MY PHYSICIAN BEFORE TAKING THE COURSE.
I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE
THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF AND IMPACT AND AGREE
TO IT OF MY OWN FREE WILL.