In checking the box below, I agree that I willingly and knowingly enter in this release with HIT WITH POWER by Gumsaba LLC, Michelle Brown, its officers, trainers, affiliates, executors in addition to the town of Alamo, CA and the city of Walnut Creek, CA.  

The purpose of my time today is to learn self defense. By checking the box, I hereby acknowledge that the following was explained to me and I agree to the following:

1. Acknowledge that self defense training is a tool for teaching individuals, but that HIT WITH POWER by Gumsaba LLC does not condone violence and promotes avoiding conflict situations. 

2. Acknowledge that I have been told that if I feel over tired, feel pain or feel out of the ordinary in any way either related to the training, or otherwise, that I should immediately stop the activity contact a physician if needed. 

3. I acknowledge that self defense, and any other related movements, are a test of one’s mental and physical limits and  carry with it potential for bodily harm. I assume the risks of participating in this activity including the inherent dangers of striking pads, heavy bags and, Body Opponent Bags, or “dummies”.

4. I agree to use the techniques I learn today only in a personal, physical attack situation. I understand that self defense is not a game and should not be played with casually. 

5. If it pertains, I have been offered the opportunity to review the facility and equipment at Gumsaba Custom Fitness and agree to participate as I deem safe.

I expressly waive, release, discharge and agree not to bring a claim or lawsuit of any type for any liability, disability, personal injury, loss of use or income of any kind Gumsaba LLC, Michelle Brown, or any of her affiliates and representatives including and insurers except for claims arising out of intentional misconduct or gross negligence. I agree that this is the full agreement between the parties, that Gumsaba LLC, nor anyone else has not verbally contradicted any of the terms of this release, and that I have entered into this agreement freely and voluntarily without force or coercion.



I am the legal guardian of the participant listed below.

I have explained to the participant items 1 through 5 above and have emphasized that if they are worried about their safety, or health, or feel pain or injury that they are to stop the activity and advise Michelle Brown. By checking the box below my name below, I agree to the conditions of this waiver.