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2. 
6. Participant Name*
7. Email*
9. Street Address*
10. City, State, ZIP*
12. Enter the start date of the course you wish to join*
    Enter the start date of the course you wish to join
14. Course

    Basic

15. Instructor

    Officer Rippamonti / Sergeant Page

19. RELEASE FORM:
    RAPE AGGRESSION DEFENSE SYSTEMS, INC.

21. The undersigned hereby acknowledges to Rape Aggression Defense Systems, Inc., its Founder, Executive Board, Staff and Instructor(s);

    That she will not participate in any aspect of the program she is uncomfortable with or considers unsafe.

    That should she choose to participate is aware of the physical nature and possible risks of injury incident to taking this practical course in self‐defense. That she is physically fit to participate in this course, involving various physical techniques, and she realizes that self‐defense techniques cannot be successfully employed in every situation, and proficiency can only be achieved and is dependent upon thorough continued practice, exercising good judgment, and a person’s natural abilities.

    The undersigned hereby releases Rape Aggression Defense Systems, Inc., its Founder, Executive Board, Staff and Instructor(s), and agrees to hold them harmless, from any liability for injury that may be incurred as a result of participation in this course, or using the strategies within for defense.

    The undersigned also acknowledges that Rape Aggression Defense Systems, Inc. is not responsible for the selection of trainers, training environments, training procedures or training equipment that an individual Instructor may use during program.

23. I HAVE READ THE ABOVE WAIVER AND RELEASE, UNDERSTAND THAT I GIVE UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND I SIGN IT VOLUNTARILY.
25. Signature*

    Please type your full name.

26. Date*
    Date
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28. 1. Receive an email copy of this form.
29. Email address

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