THIS AGREEMENT MUST BE SIGNED BY ALL MEMBERS WHO WISH TO PARTICIPATE IN ANY SOUTHERN SOUL ACADEMY SANCTIONED EVENT.
In consideration of being allowed to participate in any way in the sanctioned events of Southern Soul
Academy, LLC, I, the undersigned, personally for myself and/or as the parent(s) and/or legal guardian(s) of the minor participant, (collectively the “Participant”) acknowledge, agree, and consent as follows.
1. Acknowledges and agrees to execute the Notice to the Minor Child’s Natural Guardian, attached
hereto and incorporated herein for all purposes. 
2. Recognize and understand that martial arts training is a physical contact activity and that Participant’s
participation might result in serious injury, including permanent disability or death, and severe social
and economic loss.
3. Recognize and understand that such risk may be due to not only Participant’s own actions, but also the
action, inaction or negligence of others, the regulations of participation, or the conditions of the
premises, or of any of the equipment used.
4. Recognize that there may be other risks that are not known to Participant or to others or not reasonably
foreseeable at this time.
5. Agree to inspect the facilities, equipment and pairings prior to participation. Participant will
immediately inform an instructor if Participant’s believe that anything is unsafe or beyond Participant’s capability and refuse to participate.
6. Assume all of the foregoing risks and accept personal responsibility for any damages that may result
from injury, permanent disability or death.
7. Enter martial arts training and/or competition entirely of Participant’s own free will and understand the
importance of following the rules of training and competition. Participant has been given a copy of the
rules and regulations of Southern Soul Academy, LLC and agree to abide by the instructions given therein.
8. Participant certifies that Participant is in good physical condition, and have no disease, injury or other condition that would impair Participant’s performance or physical and mental well-being during intense training practice and/or competition.
9. Grant permission in case of injury to have a doctor, nurse, athletic training or other emergency medical personnel provide Participant with medical assistance or treatment for such injury.
10. Release, waive, discharge and covenant not to sue, Southern Soul Academy, LLC, its affiliated
organizations and governing bodies, its members, managers, officers, instructors and personnel, other
members of the organizations, participants, supervisors, coaches, sponsoring organizations or their
agents, and if applicable, owners and lessors and lessees of the premises from any and all liability to Participant or the undersigned, his or her heirs and next of kin for any and all claims, demands, losses and damages which may be sustained and suffered on account of injury, including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the releasees or
otherwise.

11. I authorize Southern Soul Academy to charge my monthly fees in accordance with the membership option chosen at sign up. I understand that no refunds will be given.

I HAVE READ THE ABOVE WARNING, WAIVER, RELEASE AND AGREEMENT TO PARTICIPATE. I UNDERSTAND ITS CONTENTS AND DO HEREBY SIGN IT VOLUNTARILY. 

NOTICE TO THE MINOR CHILD’S
NATURAL GUARDIAN
READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE
AGREEING TO LET YOUR MINOR CHILD ENGAGE IN A
POTENTIALLY DANGEROUS ACTIVITY. YOU ARE AGREEING
THAT, EVEN IF  SOUTHERN SOUL ACADEMY, LLC, OR ITS
OWNERS, AFFILIATES, EMPLOYEES, OR AGENTS, USES
REASONABLE CARE IN PROVIDING THIS ACTIVITY, THERE IS
A CHANCE YOUR CHILD MAY BE SERIOUSLY INJURED OR
KILLED BY PARTICIPATING IN THIS ACTIVITY BECAUSE
THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY
WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING
THIS FORM, YOU ARE GIVING UP YOUR CHILD’S RIGHT AND
YOUR RIGHT TO RECOVER FROM SOUTHERN SOUL
ACADEMY, LLC, OR ITS OWNERS, AFFILIATES, EMPLOYEES,
OR AGENTS, IN A LAWSUIT FOR ANY PERSONAL INJURY,
INCLUDING DEATH, TO YOUR CHILD OR ANY PROPERTY
DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A
NATURAL PART OF THE ACTIVITY. YOU HAVE THE RIGHT TO
REFUSE TO SIGN THIS FORM, SOUTHERN SOUL ACADEMY,
LLC, OR ITS OWNERS, AFFILIATES, EMPLOYEES, OR AGENTS,
HAS THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE
IF YOU DO NOT SIGN THIS FORM.

THIS AGREEMENT MUST BE SIGNED BY ALL MEMBERS WHO WISH TO PARTICIPATE IN ANY
SOUTHERN SOUL ACADEMY SANCTIONED EVENT.
In consideration of being allowed to participate in any way in the sanctioned events of Southern Soul Academy, LLC, I, the undersigned, personally for myself and/or the parent(s) and/or as legal guardian(s) of the minor participant, (collectively the “Participant” or “I”) agree and consent as follows:
ADVISORY OF RIGHTS AND RESPONSIBILITIES
1. Safety is not the sole responsibility of instructors and staff. Everyone in class is responsible for
their own safety and the safety of those around them.
2. All students have the right and responsibility to excuse themselves from any exercise they believe
will be harmful to them. All students must evaluate each situation in the context of their skill and current physical condition, and conduct each drill in a manner that is safe. If an instructor gives an instruction that is unsafe for the student, it is the student’s responsibility to inform the instructor that the activity may be unsafe. The instructor will routinely excuse the student from unsafe exercises and drills. The instructor may ask for an explanation, and the student is expected to provide one.
3. All students have the responsibility to train and conduct themselves in a manner that helps all
students and instructors remain safe. Students must give those who are training enough room to avoid interfering and avoid being accidentally struck by someone else practicing.
4. In the event of an injury, students have the right and responsibility to evaluate the extent of harm,
stopping what they are doing even if it includes a partner, and determining if it is safe to continue. Unless a student is certain that further practice will not create or worsen a problem, all students are encouraged to stop what they are doing and inform the instructor. In the event of a serious injury or the appearance of a serious injury, all students, instructors, staff and visitors notably parents, have the right to call a stop to a particular training exercise. If a student notes an unsafe training situation, which may include a student performing a skill incorrectly, a student not showing due regard for the safety of others, a defective piece of training equipment, a potentially dangerous obstacle or
condition on the floor, or anything else that may cause or lead to harm of the students, instructors, visitors or guests, then the student is expected to correct the situation if it is within his ability or to notify an instructor or staff member immediately. If something is simple to correct, such as removing an obstacle from the floor, the student should correct the situation. If the situation may require the authority of the instructor or staff, or if it is not a simple matter, then the instructor or staff member should be notified immediately.

ASSUMPTION OF RESPONSIBILITIES AND RISK
5. Martial Arts training is a potentially dangerous activity. Bumps, bruises, scrapes, scratches and
soreness are commonplace, and most students will encounter this sort of minor injury from time to time in their training. More serious injuries are possible, including sprains, strains, twists, cramps, and injuries of similar magnitude, and the student can be expected to encounter these injuries frequently. The possibility of more serious injuries exists, including broken bones, torn ligaments, though not all students encounter such serious injuries. There remains, despite safety precautions, the remote possibility of crippling or death, though this is certainly not expected in this martial arts class.
6. I understand the above statement of risk, and I understand the rights and responsibilities of
students. I assume responsibility for my own safety (or the safety of my child), understanding and accepting the risks involved with martial arts training. Even if the instructor has informed me that no serious injuries have ever happened in this school or with any of the instructors, I understand that this does not mean that there is not possibility of harm. By assuming this risk, I completely absolve all instructors, staff, guests, students, landlords, management companies and any and all other parties of liability for my harm, unless intentionally caused in criminal conduct.

NOTICE AND CONSENT TO INSTRUCTORS
7. This school seeks to make use of highly trained professional instructors, with both expertise and
experience both in the art(s) that we teach and in teaching. Classes may be taught by the head instructor or any other qualified instructor. Should an instructor be unavailable for a given class, a junior instructor, senior student or guest instructor may teach. The choice of the instructor is left to the discretion of the school. I understand that I may not always have the instructor I desire, but I shall seek to learn from whoever is teaching, to show the respect due to the position of teacher to whomever is teaching, and to conduct myself in accordance with the etiquette established at
this school. I understand that I have the responsibility for my own safety without regard to who may be teaching the class I specifically consent to any instructor of the school, instructors or staff feel are sufficiently qualifies by standards they set to teach the class. I specifically understand and agree that the full force of this document applies no matter who is teaching.

NOTICE OF PHYSICAL CONTACT
8. Complete martial arts training involves a wide variety of skills. While practicing these skills,
students may have contact with any portion of the body. The groin may be the target of kicks, strikes or grabs. The chest, buttocks, groin or any part of the body may be contacted by any part of the training partner’s body during training with martial arts techniques, or incidentally contacted while performing a martial arts technique which targets another portion of the body. When male and female students train together, or when adult and minor students train together, and in any other training combination, the purpose and intent of the school, instructors and staff is to provide an environment for all students to learn and practice martial arts and self-defense. Students are expected to conduct themselves appropriately at all times to ensure the best training results for everyone. Should any student feel that a training partner is engaging in contact beyond the scope of training, or a training partner is taking undue and unacceptable advantage of training contact, or if a student is make uncomfortable by any training exercise or partner, then that student has the right to withdraw from the exercise or drill. If the contact of a training partner appears inappropriate, the student should inform the instructor privately. If the conduct of the training partner or any training
partner appears criminal, then the instructor should be informed and the authorities may be notified either by the student or the instructor, or both.

CONSENT TO PHYSICAL CONTACT
9. I understand the nature of physical contact in martial arts training, and I understand that I have the
right to immediately withdraw from any exercise or drill in which the contact of any party seems beyond the scope of training and makes me uncomfortable. I agree to abide by the school etiquette in all manners pertaining to training, and I shall not in any way conduct myself inappropriately or take inappropriate advantage of the contact martial arts training allows.

INDEMNIFICATION BY PARENTS
10. Applicable only to parents enrolling a minor child. I agree not to bring any claim or suit against
the school, instructors, staff, guests, students, landlord, or any other parties on behalf of my child for any injury or harm sustained by any event short of a criminal act, and then only the criminal shall be the subject of such a suit. I further agree that I will not cause to be brought, nor encourage a claim or suit. I also agree not to cooperate in the bringing of such a suit or claim except insofar as I may be legally required to do so. Finally, I shall indemnify the school, instructors, staff, guests, students, and any and all additional defendants covered by this agreement for all judgments, costs, attorney fees and other expenses incurred as a result of a breach of this agreement.

ARBITRATION CLAUSE
11. Should any dispute arise between me, my child, or anyone acting on behalf of my child, regarding this school, then I specifically agree that the dispute shall be resolved in binding arbitration. Should a suit be filed in Court, I specifically authorize the Court to order the case to a binding arbitration.

SEVERABILITY
12. If any clause, sentence, phrase or statement is found unenforceable or invalid by any Court of
Law, the remainder of the document shall remain valid enforceable and the invalid clause, sentence, phrase or statement shall be struck from the document.

DURABILITY
13. This document is effective from the date signed with no expiration. Furthermore, the terms of this
document are retroactive to the beginning of training and visiting this school if this document was signed after that date.

AUTHORITY TO TREAT
14. I, give the instructors, staff and responsible adults the power to authorize medical or other
treatment of the student named subject to the limitations listed below, if any. If I am not the named student, I am the parent, guardian or responsible adult for the named student and I have legal right to grant this power. Treatment may be made without regard to whether I or any other parent, guardian or responsible person has been contacted or has consented to the specific treatment, provided it does not conflict with the limitations outlined below. This authority begins on the date signed and continues indefinitely. By granting my authorization, I assume responsibilities for all
decisions made, provided they are reasonable decisions under the circumstances based on the knowledge and understanding of the person making the decisions, and I trust their judgment and offer the benefit of the doubt to them in any claim or legal proceeding. This presumption may only be overcome by clear and convincing evidence that they acted with malice or willful gross negligence, and if so they may still be liable. I understand that the instructors, senior students, or others may have some skills in first aid, CPR, and at their discretion, I authorize them to use those skills and techniques to assist in any circumstance in which they judge their skills would be necessary or
helpful.

Applicable Law and Venue.
15. This Agreement shall be governed by the law of the State of Florida. Regardless of where this
Agreement may be prepared and/or finally executed in any legal proceeding regarding the enforcement of this Agreement venue shall lie in the Santa Rosa County, Florida.

Attorneys’ Fees.
16. In the event of any litigation arising out of this Agreement, the prevailing party shall be entitled to
recover all costs incurred, including but not limited to reasonable attorneys’ fees, with or without the institution of a lawsuit, at all trial and appellate levels and post-judgment proceedings. This paragraph shall survive the termination of this Agreement.

Waiver of Jury Trial.
17. In any dispute concerning the enforcement or interpretation of this Agreement, or of any issue
arising out of this Agreement, or the relationship created by this Agreement, or any action or proceeding between or among the parties hereto or their successors, each party hereby irrevocably waives its right ot trial by jury and agrees to trial by judge or arbitrator alone.

Authority to Bind and Guaranty by Signers.
18. The Participant hereby certifies by the signature that the signor has the full authority to bind the
Participant to this Agreement without further action. Further, the person(s) signing personally and individually agree payment of and to guarantee the payment of all fees and costs incurred under this Agreement. This paragraph shall survive the termination of this Agreement.

Benefits.
19. This Agreement shall be binding upon the parties hereto as well as to their respective legal
representatives, successors, heirs and assigns.

Entire Agreement.
20. This Agreement contains the entire understanding of the parties and is intended as a final
expression of their Agreement and a complete statement of the terms thereof, and shall not be modified except by an instrument in writing signed by the parties hereto. No waiver by either party of any default shall be deemed a waiver of any subsequent default. No representations, understandings or Agreements have been made or relied upon in the making of this Agreement other than those specifically set forth herein.

Survivorship of Provisions.
21. If any provision herein shall be deemed void, invalid or unenforceable for any reason by any court of competent jurisdiction, then only that provision shall be stricken and the remainder of this Agreement shall remain in full force and effect and shall be valid and binding upon the parties.

Responsibility for Preparation.
22. This Agreement shall not be construed more strongly against any party, regardless of who was
more responsible for its preparation.

Voluntary.
23. The undersigned has signed this Agreement freely, voluntarily, under no duress or threat of duress, without inducement, promise or guarantee being communicated to him/her.

NOTICE TO THE MINOR CHILD’S NATURAL GUARDIAN
24. READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO LET YOUR MINOR CHILD ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY. YOU ARE AGREEING THAT, EVEN IF  SOUTHERN SOUL ACADEMY, LLC, OR ITS OWNERS, AFFILIATES, EMPLOYEES, OR AGENTS, USES REASONABLE CARE IN PROVIDING THIS ACTIVITY, THERE IS A CHANCE YOUR CHILD MAY BE SERIOUSLY INJURED OR KILLED BY PARTICIPATING IN THIS ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY
WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM, YOU ARE GIVING UP YOUR CHILD’S RIGHT AND YOUR RIGHT TO RECOVER FROM SOUTHERN SOUL
ACADEMY, LLC, OR ITS OWNERS, AFFILIATES, EMPLOYEES, OR AGENTS, IN A LAWSUIT FOR ANY PERSONAL INJURY, INCLUDING DEATH, TO YOUR CHILD OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A NATURAL PART OF THE ACTIVITY. YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM, SOUTHERN SOUL ACADEMY, LLC, OR ITS OWNERS, AFFILIATES, EMPLOYEES, OR AGENTS, HAS THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN THIS FORM.

Southern Soul Academy, LLC

Image and Likeness Consent and Release Form

I hereby understand and agree that Southern Soul Academy, LLC (“SSA”), and others
working on their behalf, and their respective licensees, successors, and assigns shall have: (i) the
unlimited right and permission to use, distribute, publish, exhibit, digitize, broadcast, display,
and reproduce my likeness, name, picture, voice, member/customer status or any material
whatsoever anywhere in the world for any purpose including, without limitation, for purposes of
any commercial, advertising, and/or trade, in connection with the SSA, (ii) sole ownership and
sole authority over the content of any SSA advertisements, promotions and other materials which
may contain my name, image, likeness, and/or member/customer status, and (iii) all ownership
rights, including copyright and all other intellectual property rights of any advertisement,
promotions, and any other materials produced by the SSA or at the SSA’s direction and any
negatives or copies thereof which may contain my name, image, likeness, and/or
member/customer status.
I hereby irrevocably authorize SSA to edit, alter, copy, exhibit, publish or distribute any
image, audio, and/or video for purposes of publicizing SSA's programs or for any other lawful
purpose. I understand I will receive no notice of the SSA’s use of my name, image, likeness,
and/or member/customer status. I acknowledge that I have voluntarily agreed to have my picture
taken and/or my voice or likeness recorded and I waive the right to inspect or approve the
finished product, including any written or electronic copy, wherein my name, image, likeness,
and/or member/customer status appears. Additionally, I waive any right to any claim of royalties,
consideration, or other compensation and any other claims (including, without limitation, claims
based upon invasion of privacy, defamation, or right of publicity) arising or related to the
production, exhibition, or other use of the images, audio, and/or video captured of me, or any use
thereof. In addition, I hereby hold harmless and release and forever discharge SSA, its directors,
officers, employees, and agents from all claims, demands, and causes of action, including,
without limitation, any and all claims for invasion of privacy, libel, and violations of the law,
arising out of or relating to the production, exhibition, or other use of the images, audio, or video
captured of me which I, my heirs, representatives, executors, administrators, or any other persons
acting on my behalf or on behalf of my estate have or may have by reason of this Release.
This Release shall be binding upon me and my heirs, personal representatives, and
successors. This Release shall be governed and construed with the laws of the State of Florida
without giving effect to its conflict of law provisions. In the event legal action is necessary to
enforce this Release, the prevailing party has the right to payment by the other party of
reasonable attorneys’ fees and costs, including any appeal and any post-judgment actions, as
applicable. Any legal action arising from or related to this Release shall be filed and heard in
Santa Rosa County, Florida, except as prohibited by applicable law. Any disputes regarding this
Agreement shall be within the jurisdiction of the courts of Santa Rosa County, Florida. I am 18
years of age and am competent to contract in my own name. I have the full right and authority to
grant the rights hereunder and I agree this Release does not in any way conflict with any existing
commitment on my part. I have read this Release before signing below and I fully understand the
contents, meaning, and impact of this Release.