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    Home School Kids Program

    Duration Ongoing
    Access Unlimited
    Cost $20.00
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    Little Sheep Dog Monthly Membership 6-10yrs

    Duration Ongoing
    Access 2 sessions / week
    Cost $65.00 / month + $50.00 signup fee
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    Monthly Membership

    Duration 1 month
    Access Unlimited
    Cost $99.00 / month + $50.00 signup fee
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    Monthly Membership Package (3 or more family members)

    Duration 1 month
    Access Unlimited
    Cost $225.00 / month + $50.00 signup fee
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    ONE TIME DROP IN FEE

    Duration Ongoing
    Access 1 sessions
    Cost $20.00
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    PUNCH CARD 10 CLASS

    Duration Ongoing
    Access 10 sessions
    Cost $150.00 + $50.00 signup fee
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    Women's Self Defense Class - 3 Day Series - Saturday May 6, 13, 20

    Duration 3 weeks
    Access 3 sessions
    Cost $30.00
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Membership Documents

Waiver / liability release

RELEASE OF LIABILITY

READ CAREFULLY - THIS AFFECTS YOUR LEGAL RIGHTS

In exchange for participation in the activity of Brazilian Jui Jitsu, Self-Defense organized by Potter Self-Defense Academy, of 1713 17th Street, Cody, Wyoming, 82414 and/or use of the property, facilities and services of Potter Self-Defense Academy, I agree for myself and (if applicable) for the members of my family, to the following:

1. AGREEMENT TO FOLLOW DIRECTIONS. I agree to observe and obey all posted rules and warnings, and further agree to follow any oral instructions or directions given by Potter Self-Defense Academy, or the employees, representatives or agents of Potter Self-Defense Academy.

2. ASSUMPTION OF THE RISKS AND RELEASE. I recognize that there are certain inherent risks associated with the above described activity and I assume full responsibility for personal injury to myself and (if applicable) my family members, and further release and discharge Potter Self-Defense Academy for injury, loss or damage arising out of my or my family's use of or presence upon the facilities of Potter Self-Defense Academy, whether caused by the fault of myself, my family, Potter Self-Defense Academy or other third parties.

3. INDEMNIFICATION. I agree to indemnify and defend Potter Self-Defense Academy against all claims, causes of action, damages, judgments, costs or expenses, including attorney fees and other litigation costs, which may in any way arise from my or my family's use of or presence upon the facilities of Potter Self-Defense Academy.

4. FEES. I agree to pay for all damages to the facilities of Potter Self-Defense Academy caused by any negligent, reckless, or willful actions by me or my family.

5. CONSENT. I {name} consent to the participation of {name} {dob} {address}, in the activity of Brazilian Jui Jitsu, Self-Defense, and agree on behalf of the above minor to all of the terms and conditions of this Agreement. By signing this Release of Liability, I represent that I have legal authority over and custody of the minors in which I am giving consent. 

6. MEDICAL AUTHORIZATION. In the event of an injury to the above minor during the above described activities, I give my permission to Potter Self-Defense Academy or to the employees, representatives or agents of Potter Self-Defense Academy to arrange for all necessary medical treatment for which I shall be financially responsible. This temporary authority will begin on the date in which I sign up as a member and will remain in effect until terminated in writing by the undersigned or when the above described activities are completed. Potter Self-Defense Academy shall have the following powers:

a. The power to seek appropriate medical treatment or attention on behalf of myself, family, or my child as may be required by the circumstances, including without limitation, that of a licensed medical physician and/or a hospital;

b. The power to authorize medical treatment or medical procedures in an emergency situation; and

c. The power to make appropriate decisions regarding clothing, bodily nourishment and shelter. 

7. APPLICABLE LAW. Any legal or equitable claim that may arise from participation in the above shall be resolved under Wyoming law.

8. NO DURESS. I agree and acknowledge that I am under no pressure or duress to sign this Agreement and that I have been given a reasonable opportunity to review it before signing. I further agree and acknowledge that I am free to have my own legal counsel review this Agreement if I so desire. I further agree and acknowledge that Potter Self-Defense Academy has offered to refund any fees I have paid to use its facilities if I choose not to sign this Agreement.

9. ARM'S LENGTH AGREEMENT. This Agreement and each of its terms are the product of an arm's length negotiation between the Parties. In the event any ambiguity is found to exist in the interpretation of this Agreement, or any of its provisions, the Parties, and each of them, explicitly reject the application of any legal or equitable rule of interpretation which would lead to a construction either "for" or "against" a particular party based upon their status as the drafter of a specific term, language, or provision giving rise to such ambiguity.

10. ENFORCEABILITY. The invalidity or unenforceability of any provision of this Agreement, whether standing alone or as applied to a particular occurrence or circumstance, shall not affect the validity or enforceability of any other provision of this Agreement or of any other applications of such provision, as the case may be, and such invalid or unenforceable provision shall be deemed not to be a part of this Agreement.

11. DISPUTE RESOLUTION. The parties will attempt to resolve any dispute arising out of or relating to this Agreement through friendly negotiations amongst the parties. If the matter is not resolved by negotiation, the parties will resolve the dispute using the below Alternative Dispute Resolution (ADR) procedure.

Any controversies or disputes arising out of or relating to this Agreement will be submitted to mediation in accordance with any statutory rules of mediation. If mediation is not successful in resolving the entire dispute or is unavailable, any outstanding issues will be submitted to final and binding arbitration under the rules of the American Arbitration Association. The arbitrator's award will be final, and judgment may be entered upon it by any court having proper jurisdiction.

12. EMERGENCY CONTACT. In case of an emergency, please call {contact_name} {contact_ relation} at {contact_phone} we will call the information provided in your membership agreement and electronic file. 

I HAVE READ THIS DOCUMENT AND UNDERSTAND IT. I FURTHER UNDERSTAND THAT BY SIGNING THIS RELEASE, I VOLUNTARILY SURRENDER CERTAIN LEGAL RIGHTS.

{sign_date}
Done Clear Sign Below:

COVID-19 LIABILITY WAIVER

READ CAREFULLY - THIS AFFECTS YOUR LEGAL RIGHTS

In exchange for use of the property, facilities, and services of Potter Self-Defense Academy, of 1713 17th Street, Cody, Wyoming, 82414, I, {name}, of {address}, agree for myself and (if applicable) for the members of my family, to the following:

1. AGREEMENT TO FOLLOW DIRECTIONS. I agree to observe and obey all posted rules and warnings regarding COVID-19, and further agree to follow any oral instructions or directions given by Potter Self-Defense Academy, or the employees, representatives or agents of Potter Self-Defense Academy.

2. ASSUMPTION OF THE RISKS AND RELEASE. I recognize that there are certain inherent risks associated with the above described activity regarding COVID-19, acknowledge the contagious nature of COVID-19 and understand that CDC and public health authorities recommend the practice of social distancing, and I assume full responsibility for personal injury to myself and (if applicable) my family members, and further release and discharge Potter Self-Defense Academy for injury, loss or damage arising out of my or my family's use of or presence upon the facilities of Potter Self-Defense Academy, whether caused by the fault of myself, my family, Potter Self-Defense Academy or other third parties.

I acknowledge that Potter Self-Defense Academy has followed all local and state requirements regarding the coronavirus pandemic to reduce the spread of COVID-19. I acknowledge that Potter Self-Defense Academy cannot guarantee that I will not become infected with COVID-19.

3. INDEMNIFICATION. I agree to indemnify and defend Potter Self-Defense Academy against all claims, causes of action, damages, judgments, costs or expenses, including attorney fees and other litigation costs, which may in any way arise from my or my family's use of or presence upon the facilities of Potter Self-Defense Academy.

4. APPLICABLE LAW. Any legal or equitable claim that may arise from participation in the above shall be resolved under Wyoming law.

5. NO DURESS. I agree and acknowledge that I am under no pressure or duress to sign this Agreement and that I have been given a reasonable opportunity to review it before signing. I further agree and acknowledge that I am free to have my own legal counsel review this Agreement if I so desire. I further agree and acknowledge that Potter Self-Defense Academy has offered to refund any fees I have paid to use its facilities if I choose not to sign this Agreement.

6. ENFORCEABILITY. The invalidity or unenforceability of any provision of this Agreement, whether standing alone or as applied to a particular occurrence or circumstance, shall not affect the validity or enforceability of any other provision of this Agreement or of any other applications of such provision, as the case may be, and such invalid or unenforceable provision shall be deemed not to be a part of this Agreement.

7. DISPUTE RESOLUTION. The parties will attempt to resolve any dispute arising out of or relating to this Agreement through friendly negotiations amongst the parties. If the matter is not resolved by negotiation, the parties will resolve the dispute using the below Alternative Dispute Resolution (ADR) procedure.

Any controversies or disputes arising out of or relating to this Agreement will be submitted to mediation in accordance with any statutory rules of mediation. If mediation is not successful in resolving the entire dispute or is unavailable, any outstanding issues will be submitted to final and binding arbitration under the rules of the American Arbitration Association. The arbitrator's award will be final, and judgment may be entered upon it by any court having proper jurisdiction.

I HAVE READ THIS DOCUMENT AND UNDERSTAND IT. I FURTHER UNDERSTAND THAT BY SIGNING THIS RELEASE, I VOLUNTARILY SURRENDER CERTAIN LEGAL RIGHTS.

I understand & agree this is a legal representation of my signature.

 
 
Done Clear Sign Below:

Membership Agreement

This Membership Agreement (the Agreement) is effective {date} by and between the Potter Self-Defense Academy, hereinafter referred to as the gym, accessed via www.potterselfdefense.com with a business address of 1713 17th Street, Cody, Wyoming 82414, and all current and future members of Potter Self-Defense Academy hereinafter referred to as "Member".

By accessing, browsing or using the www.potterselfdefense.com website or by selecting I Accept during the membership registration, you represent that you have read, understand and agree to be bound by the terms and conditions of this Membership Agreement hereinafter referred to as Agreement.

Membership, Term, and Payment.
a. Membership. Your Membership entitles you to use the Facility until your
Membership Expiration Date, below, and is created when you execute this Agreement, including
fulfilling all Membership Qualifications according to Article II, below, and pay your Fee,
defined below.

b. Fee. Your Fee includes your initial fee (“Initial Fee”), and a fee based on the length
of your membership (“Membership Fee”). Your Initial Fee is due upon execution of this
Agreement. The monthly membership fee is $99.00 allowing all access to the classes you qualify to participate in, which is based on age. Classes start at age six years old to adult, each class is set up by age thus your age may restrict you from attending all of the classes offer by Potter Self-Defense Academy. The initial fee Membership Sign up fee of $50.00 is due when you sign up for membership which covers your ghee for youth members and a rash guard for adult members; this is also determined by size, your child's size may categorized them into adult sizes which may change the rate of the apparel. 


MEMBER INFORMATION:

{name}

{address}

{phone}

{dob}

{email}

EMERGENCY CONTACT:
{contact_name}

{contact_phone}

{contact_relation}

Your membership fee is due on the first of each month aside from the month you sign up for membership, which may be prorated. The Membership Start Date begins on the day you sign this agreement and is renewed automatically monthly. We do require automatic recurring payments, so a payment method must be on file. 

c. Billing Authorization – The member agrees to automatic withdraw using the payment method provided during signing up for membership. The member understands his or her responsibility in notifying Potter Self-Defense Academy if there payment method changes. If the payment method declines you will not be able to continue attending classes or continue as a member of Potter Self-Defense Academy.

d. Membership Freeze. A Freeze is effective only upon advance written notice to the Gym, sent to the address as set forth in this Agreement, which notification shall include the period of time to
which you request the Freeze apply. In no instance shall a Freeze apply retroactively. During a
Freeze, you may not use the Facility or engage in a Training Session. If you pay your
Membership Fee in equal monthly installments, you will not be billed during your Freeze;
payments shall resume upon the expiration of your Freeze. 

e. Closings. From time to time, the Gym may partially or fully close and be unavailable
for use for reasons including, but not limited to, renovation, repair, special events, or holidays.
The Gym will make every effort to minimize disruption to members during these periods. Hours
of operation will be displayed in the Gym and may be modified from time to time.

MEMBERSHIP QUALIFICATIONS
1. All of the Required Forms must be completed and submitted to the Gym prior to the use
of any Facility or commencement of a Training Session. The Required Forms include (i) this
Agreement; (ii); (ii) COVID-19 Release of Liability; and (iii) the Informed Consent and Release of Liability. Required Forms are subject to change.
2. You attest that you are at least eighteen (18) years of age. {Initial}

MEMBER RESPONSIBILITIES
1. Safe use of Facility and equipment. You agree to abide by all policies, guidelines, rules,
and regulations (together, the “Gym Rules”) for safe use of the Facility and equipment,
including following any verbal or written instructions provided by the trainer, and not
endangering any other member. The Gym Rules are subject to change.
You agree to seek instruction from the trainer or other Gym personnel in the
use of all equipment, including, but not limited to, fitness machines, free-weights, mats, and cardioaerobic equipment, prior to use.

You acknowledge and agree that (i) there are risks associated with any strenuous
athletic or physical activity, the use of exercise equipment, and participation in an exercise
program, mixed martial arts, and brazilian jui jitsu; (ii) use of the Facility and exercise equipment is undertaken by you voluntarily; and (iii) such use may include the risk of serious bodily injury or death. {initial}

2. Physician Consent. You agree that, prior to undertaking any physical activity at the Gym,
including but not limited to Training Sessions, you will advise your physician of the details of
the activities in which you plan to participate and will obtain your physician’s consent to or
approval of those plans.

3. Representation of level of health and fitness. You represent to the Gym that you are in
good health and have no disability, impairment, injury, disease, or ailment that prevents you
from engaging in active or passive exercise or which would cause an increased risk of injury or
adverse health consequences as a result of such exercise.

4. The Gym will not provide medical treatment. You understand and acknowledge that
neither the Gym nor the personal trainers nor other Gym personnel have expertise in diagnosing,
examining, or treating any medical condition. In the event you experience any illness, injury,
discomfort, impairment, or other health problem (together referred to as a “Health Problem”)
prior to or during a Training Session or your use of the Facility, you agree to (i) immediately
inform your personal trainer or gym personnel of such Health Problem, and (ii) consult
your physician and reconfirm your physician’s consent to or approval of your continued
participation in activities at or with the gym.

5. You agree that while you are using the Facility or participating in a Training Session to
refrain from the use and that you will not be under the influence of any (i) medication that may
impair your physical or mental capabilities, (ii) alcohol, or (iii) drugs. You acknowledge and
agree that such use or influence may increase the risk of serious bodily injury or death to
yourself or others.

6. The Gym urges you to not bring any valuables in the Facility. You agree that the Gym
will not be liable for the loss or theft of, or damage to, your personal property.

RIGHTS TO CANCELLATION
1. Members have the right to discontinue and cancel the membership at any time with written notice to the Gym. It must be delivered in person, cancelled through the website www.potterselfdefense.com, or by United States mail. Your notice of cancellation shall be accompanied by the Required Forms, including this Agreement, your membership card, and any other documents or evidence of membership previously delivered to you. If payment has already been processed prior to receiving notification of cancellation, no refund will be given. If you miss training sessions, are late to sessions, or do not show up for session, no refund will be given in whole or in part.

2. The Gym reserves the right to cancel this Agreement and terminate your Membership or
other privileges granted by this Agreement in the event of a Member Default. A Member
Default includes (i) your failure to comply with any of the Gym Rules; (ii) intentional or
negligent misrepresentation of information contained in this Agreement, (iii) failure to make
timely payment of your obligations under this Agreement, (iv) sexual misconduct or sexual harassment directly or insinuated will result in termination of your membership, or (v) unnecessary hostility or misuse of skill in the gym or outside of the gym will result in termination of your membership.  A terminated Member shall remain fully liable to the Gym for all Fees and any other expenses payable to the Club.

MISCELLANEOUS
1. Confidentiality. Information you provide to the Gym pursuant to this Agreement,
including but not limited to that information provided in the Required Forms (the “Confidential
Information”), will be treated by the Gym and its personnel as confidential, and will not be
released or revealed to any person outside of the Gym without your express written consent or as
required by law. The Gym shall employ reasonable and appropriate safeguards to protect your
Confidential Information. 

2. Assignment. You may not assign, resell, or transfer to any other person or entity the
rights allowed or obligations required by this Agreement.

3. Waiver. It is understood and agreed that no failure or delay of either party to this
Agreement, in exercising any right, power, or privilege provided under this Agreement, shall
operate as a waiver, nor shall any single or partial exercise preclude any other or further exercise
or the exercise of any right, power, or privilege provided under this Agreement.

4. Governing Law. This Agreement shall be governed by the laws of the Wyoming.

5. Enforcement. If any provision of this Agreement is held to be invalid or unenforceable
by a court of competent jurisdiction, such holding shall not affect the validity or enforceability of
any other provision, which shall remain in full force and effect, and the provision held invalid or
unenforceable shall be deemed modified so as to give the provision the maximum effect
permitted by applicable law.

6. Attorneys’ Fees. In the event either party institutes legal proceedings against the other
for breach of or interpretation of this Agreement, the party against whom a judgment is entered
will pay all reasonable costs and expenses relative thereto, including reasonable attorneys’ fees
of the prevailing party at pre-trial, trial and all appellate levels.

7. PHOTO AND VIDEO RELEASE/CONSENT AUTHORIZATION: I, Hereinafter "signer," for good and valuable consideration, give permission to Potter Self-Defense Academy, hereinafter "company" give permission to make audio recordings, still recordings of myself or my minor child, hereinafter "subject" for the purpose of marketing. I understand that subjects first name and portrait, video clips, picture, still recording in all forms of media "likeness" may be used for the purpose of the companies business and advertising, however will not be sold or traded for use outside of company use. My heirs, executors, and administrators shall be bound by this instrument. If I wish to disallow the use of photo or video or the other media, it is the responsibility of the subject, to notify the company in writing of my withdraw. 

RULES AND REGULATIONS

GENERAL CONDUCT - "NO EGOS. BE NICE."

-Please, show respect and consideration for other users of the gym. Abusive, rude, indecent and/or disruptive behavior is strictly prohibited. Be considerate to other members' rights, privileges, and safety while you are training.

-Please, respect and comply with the instructions of the instructors and/or the staff of the Gym.

-Have respect for the gym, your instructor and for your fellow students.

-Arrive to class on time and ready to train. Classes will begin promptly.

-Please, show up to each class with the necessary equipment and appropriate training attire required.

-Use of excessive force outside of the gym is unacceptable and will not be tolerated. If you are found using excessive force that is NOT deemed self-defense, your membership will be terminated immediately.

-Please, be aware that your conduct inside and outside of the Gym has a direct effect on the Gym, your Coaches, and your training partners. Criminal offenses including, but not limited to, those involving: the use or threat of violence; domestic violence and other forms of partner abuse; theft and other property crimes; sex offenses; obstruction or resisting arrest; disorderly conduct; fraud, etc., could result in gym membership termination. 

SAFETY – "SAFETY FIRST"

-You must not train or use the Gym facilities when unwell, ill, or injured. Please notify trainers immediately if you are feeling unwell, fatigued, dizzy or are experiencing any physical discomfort during training.

-Please, do not train with any open cuts or wounds or with any itching or visible rash which is exposed unless it has been ascertained by a health professional that such rash is not contagious.

-Please, maintain a reasonable standard of hygiene due to the close contact associated with martial arts. Trainees are encouraged to be clean and freshened up before training and ensure fingernails and toenails are kept short. Deodorant is appreciated!

-The following activities are not allowed unless supervised by an instructor:

  1. A) Full contact sparring/fighting
  2. B) Judo/Jiujitsu/wrestling throws, slams and/or takedowns

You must always be alert and respond quickly to “tap outs” whether actual or verbal and/or "knock outs" (which includes any event where it appears the other party is unable to defend himself/herself reasonably). When in doubt, err on the side of caution and immediately release and/or cease the maneuver which led to the said "tap out" or "knock out".

-Always exercise reasonable caution not to cause undue injury to others.

-Take all reasonable steps and precautions to protect yourselves and train in a manner which is safe for yourselves and others.

-Bullying and/or unnecessarily aggressive behavior at the gym will NOT be tolerated.

ENVIRONMENT – "RESPECT THE MAT"

-Please pick up after yourself and keep the Gym premises in a clean and neat state.

-Shoes, slippers, or other footwear are not allowed on the training mats 

-No food or drinks at any time are allowed on the training mats.

-Bathrooms should be kept as clean and dry as possible. Please, wipe your feet when leaving the bathrooms.

-GYM PROPERTY – "TREAT IT BETTER THAN YOU WOULD TREAT YOUR OWN"

-Treat all Gym property with care.

-Please, do not remove any of the Gym property from the Gym without permission of the management.

By signing this agreement, I understand and agree to the rules, regulations, responsibility, and policy of this agreement. {initial}

Done Clear Sign Below:

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  • Phone

    (307) 250-5770

  • Address

    1713 17th Street
    Cody, WY 82414

  • Email

    potterselfdefense@gmail.com

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