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RELEASE FROM LIABILITY WAIVER FORM

EVENT DATE: mm/dd/yyyy

PROMOTERS NAME: EVENT NAME: -

NAME OF VENUE: The Salisbury Center

PHYSICAL EVENT LOCATION: 8890 Mathis Ave, Manassas, VA 20110

This RELEASE of Liability is a Legal Contract binding upon You, The VCSS (Virginia Combat Sports Sanctioning), The Promoter named above and any and all of these companies, federations or organizations, associates, officials, employees and staff related to the event named above. You hereby consent and agree to completely accept alone any and all risks of injury or death, and You verify and confirm all of the below statements by placing a checkmark at each numbered item as well as signing your full name below.

READ IT CAREFULLY AND OBTAIN LEGAL ASSISTANCE IF YOU DO NOT UNDERSTAND IT.

Affirmation

Affirmed

- Voluntary Application. I, the undersigned, acknowledge and state that I have ACCEPTED to compete in the EVENT NAMED ABOVE on the DATE NAMED ABOVE.

Affirmation

Affirmed

- Assumption of risk. I am aware and understand that in general, full contact fighting is a dangerous and hazardous activity, and in particular, the techniques and methods of this convention, all in which as a competitor in this competition I shall be participating, is an extremely dangerous and hazardous event. I am voluntarily and of my own free will submitting an application to compete in this event with full knowledge and understanding of the hazards involved.

Affirmation

Affirmed

-Release. In consideration for (a) being accepted as a competitor of the EVENT NAMED ABOVE on the DATE NAMED ABOVE, (b) being entitled to participate in activities Sanctioned by the VCSS (Virginia Combat Sports Sanctioning) and Promoted by the PROMOTER named above and (c) being permitted to use facilities and equipment, whether owned or leased by The VCSS (Virginia Combat Sports Sanctioning) and/or the PROMOTER named above and all associates, officials, employees, staff and fellow participants and trainers/coaches. I hereby agree that I, my heirs, distributees, guardians, successors in interest and legal representatives (collectively referred to as "Releasor") will not make a claim or file an action or suit against, sue, or attach the property of (a) the EVENT NAMED ABOVE on the DATE NAMED ABOVE which would include The VCSS (Virginia Combat Sports Sanctioning) and the PROMOTER named above or any and all of their officials, affiliated organizations, and/or their directors, officers, employees, agents or managers, fellow participants, trainers, and (b) any or all manufacturers, distributors, wholesalers, suppliers and/or retailers of the facilities and equipment I will use in connection with any and all activities Sanctioned by The VCSS (Virginia Combat Sports Sanctioning) and/or Promoted by PROMOTER named above and any and all of these companies, federations or organizations associates, officials, employees and staff (collectively referred to as the "suppliers"), (The organization) and the PROMOTER named above and any and all of these companies, federations or organizations, associates, officials, employees and staff, and the Suppliers shall collectively be referred to as "Releasees), for damages, injury, emotional distress claims, bodily injury claims, and punitive damages, whether known or unknown, foreseen or not, due to or resulting from the acts, conduct, negligence, or misfeasance of, or omissions or failures to act by, the Releasees, or any of them.

Affirmation

Affirmed

- Application of State Law. In further consideration of (a) being accepted as a competitor in the EVENT NAMED ABOVE on the DATE NAMED ABOVE, (b) being entitled to participate in activities conducted and Sanctioned by The VCSS (Virginia Combat Sports Sanctioning) and/or Promoted by the PROMOTER named above and any and all of these companies, federations or organizations associates, officials, employees and staff, and (c) being permitted to use facilities and equipment, whether owned or leased by The VCSS (Virginia Combat Sports Sanctioning) and the PROMOTER named above and any and all of these companies, federations or organizations associates, officials, employees and staff, I hereby agree that this Release from Liability shall be interpreted under and construed in accordance with the laws of only the State or Province of Country named above, without the benefit of and fully disregarding all conflicts of the laws provisions of the State or Province of Country named above, so that any and all disputes, contentions, disagreements or controversies arising from or related to (a) this Release from Liability, (b) the application for acceptance into the Challenge, or (c) my participation in any and all activities sanctioned by The VCSS (Virginia Combat Sports Sanctioning) and Promoted by the PROMOTER named above and any and all of these companies, federations or organizations associates, officials, employees and staff, shall be interpreted under and in accordance with only the laws of the State or Province of Country named above regardless of my domicile or residency; and that the only court in which an action or suit may be brought in connection with the foregoing shall be the court of original jurisdiction of the State or Province of Country named above. Further, I waive any right I may have to assert the doctrine of forum non conveniens or similar doctrine or to object to venue with respect to any proceeding brought in accordance with this Release, and I stipulate that the courts of the State or Province of Country named above shall have in personal jurisdiction and venue over me for the purpose of litigation any dispute, controversy, or proceeding arising out of or related to this Release, The VCSS (Virginia Combat Sports Sanctioning) and the PROMOTER named above and any and all of these companies, federations or organizations associates, officials, employees and staff.

Affirmation
Affirmed

- Health Advisory and Condition. I hereby acknowledge and understand that participating in this event involves extremely strenuous physical activity and heavy physical contact, and that I have been advised to consult a physician before commencing and undertaking such activity. I hereby represent that, to the best of my knowledge, I am in good physical health and condition, sufficient to undertake this dangerous and hazardous competition.

Affirmation

Affirmed

- Knowing and Voluntary Execution. I hereby declare that I have read this Release from Liability, and that I fully understand the meaning and importance of its contents. I acknowledge that this Release is a binding contract among The VCSS (Virginia Combat Sports Sanctioning) and the PROMOTER named above and any and all of these companies, federations or organizations associates, officials, employees and staff and myself, and that under this contract I am releasing The VCSS (Virginia Combat Sports Sanctioning) and the PROMOTER named above and any and all of these companies, federations or organizations associates, officials, employees and staff from all liability for claims I may have against them. I further declare and represent that I am at least 18 years of age, that I have full legal capacity to be bound by this contract, and that I am signing this contract of my own free will and accord.

Executed in the City & State as listed above on the of the month of , in the year 20 .

Applicant/Releasor Printed Name:

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Timestamp

Audit

March 31, 2024 9:07 pm EDT

VCSS Release from Liability Waiver Form Uploaded by Jeff Salisbury - [email protected] IP 73.132.186.147

April 27, 2024 6:42 pm EDT

Ronnie Rodriguez - [email protected] added by Jeff Salisbury - [email protected] as a CC'd Recipient Ip: 73.132.186.147