Women’s Self Defense Application – CHRISTIAN COUNTY SHERIFF’S OFFICE

Today's Date *

Terms of Use *

I have read, understand, and acknowledge the Terms of Use. To view Terms of Use, please visit the Christian County Sheriff’s Office website.

Name *

First

Last

Email *

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

I am a resident of Christian County, Missouri *

Yes
No

Emergency Point of Contact: *

First

Last

Relationship: *

Phone *

I, the undersigned participant, being the age of 18 or above (or, if under the age of 18, having obtained the signature of my legal guardian on this form in addition to my own), desire to participate in activities with the organization listed above, which may include but not be limited to physical activities related to self-defense. I realize these activities are potentially hazardous. I should not engage in these activities unless I am alert and observant, which I represent myself to be. I assume any and all risks associated with these activities including, but not limited to falls, personal injury, collision with other persons, and motor vehicle transportation, all such risks being known and appreciated by me. I attest that I am sufficiently physically fit to participate in these activities. I understand the possible risks of being permitted to participate in activities hosted by the organization named above. I, for myself and my personal representatives, heirs, and assigns, do hereby hold harmless and release, waive, discharge, and covenant not to sue the Christian County Sheriff’s Office or the owner of the venue. Furthermore, I release Christian County Sheriff’s Office, officers, employees, volunteers, and agents (hereinafter collectively referred to as “ORGANIZER”) from any and all claims or liability on account of injury, death, loss, harm, or damage to the person or property of the undersigned of any kind or nature whatsoever arising out of, or in any way connected with the undersigned’s participation in the activities even though the claim or liability may arise out of the negligence or carelessness on the part of Christian County Sheriff’s Office, or any third person, whether foreseen or unforeseen, known or unknown. The undersigned hereby expressly agrees that this release and waiver is intended to be as broad and inclusive as permitted by the laws of the State of Missouri and that if any portion hereof is held invalid, it is agreed that the balance, notwithstanding, continue in full legal force and effect. The undersigned further states that he or she has carefully read the foregoing release and waiver of liability, knows the contents thereof and has agreed to sign this release and waiver of liability as his or her own free act and deed. I also declare that I will take all necessary and/or recommended precautions to ensure my own person against physical and/or mental injury and property loss or damage. This includes, but is not limited to, following printed or verbal instructions given by those in positions of authority or leadership. I further declare that I assume responsibility for my actions or behaviors that may conflict with accepted standards, Christian County Sheriff’s Office requirements for participants, common sense, or the instructions I receive from activity leader(s) either before or during this activity. I do hereby affirm that I am covered under my guardian’s medical policy or otherwise have adequate medical insurance. I understand that the Christian County Sheriff’s Office does not maintain any insurance policy covering any circumstance arising from my participation in this activity or any event related to that participation. As such, I am aware that I should review my personal insurance coverage. *

I agree
I decline

Date of Birth *

Must be seventeen (17) or older.