Short Term Waiver & Release of Liability

I, the undersigned, knowingly and without duress, do voluntarily submit this form to the said Liu Institute International and affiliates.  I do hereby assume all risk of personal, physical, or mental disabilities, injuries or losses, which may result from participating in the Liu Institute International and acting for myself, my heirs, personal representatives, and assignees, I hereby release the said  Liu institute and affiliates, their officers, agents, representatives, servants, employees, and all other related members from all claims, actions, suits, controversies, claims at law or in equity by stand that there is a risk of injury in all activities, and I assume full responsibility for my actions, during and in connection with said Liu Institute and affiliates  I fully understand that any medical treatment given to me will be of the first aid type only, and I consent to such emergency treatment if deemed necessary.  I further consent that any photos furnished by me, or any photos/videos taken of me in connection with Liu institute International and affiliates  be used for publicity, or television and I waive all compensation in regards thereto.

By signing your name and date below - you indicate that you consent to the Statement of Waiver & Release of Liability above and that you are at least 18 years of age.  For individuals under 18 years of age, a parent must sign in lieu of the minor's consent:

Signature of Participant or Legal Guardian of Participant:

______________________________________________________Date of Signature_________________