SSGT Student/Operator Information Please fill out the form below! SSGT Student/Operator Information If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required Student/Operator's Last Name * Student/Operator's First Name * Student/Operator's Email * Student/Operator's Date of Birth * Male Female Student/Operator's City * Student/Operator's State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Student/Operator's Agency * City of Agency * Agency's State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Course Lead Instructor's Last Name * Course Lead Instructor's First Name * Course Lead Instrucor's Agency * Course Lead Instructor's State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Month(s) of the Year Training was Conducted * I will be attending the SSGT Vanguard Level One Course! I will be attending the SSGT Vanguard Level Two Course! I will be attending the SSGT Alpha Course! I affirm the fact that I am completely capable both mentally and physically of attending and completing the SSGT program(s) listed above and verify that affirmed fact by checking the box below. * In consideration of acceptance into Triad Martial Art’s Strategic Self-Defense and Grappling Tactics, (SSGT) schools, classes, courses, and/or seminars, the undersigned and/or his/her department/division/agency does assume and accept all responsibility for any and all risk or damages or injury that may occur to the student/instructor (undersigned) while attending schools, classes and/or seminars, participating in exercises, participating in exhibitions, or in using SSGT course equipment or facilities or following SSGT course instructions in or out of an SSGT course, class, school, seminar or location. The undersigned student/instructor and/or his/her department/division/ agency does hereby release and discharge, Johnny Lee Smith, Triad Martial Arts, Inc., SSGT, his and its employees, agents, instructors, and other students from all claims, demands, rights of cause of action, present or future, whether known, and anticipated or unanticipated and resulting from or arising out of, or incident to the students’s use (or intended use) of SSGT schools, classes, seminars, courses or locations, or facilities and equipment in such places or as a result of, or incident to, engaging in SSGT schools, classes, seminars, courses , exercise or otherwise following SSGT instructions anywhere. I/we recognize and acknowledge that defensive tactics, martial arts, SSGT, is a contact self-defense activity and therefore can be dangerous. I/we also recognize and acknowledge that the application of force against any and all persons must be objectively reasonable based on the totality of circumstances at the time said force is applied. I have read and understand the foregoing assumption of risk agreement and release and verify that understanding by checking the box below. *
