Name *

First Name

Last Name

Arrival Date in Detroit (if flying)

MM

DD

YYYY

Time of arrival in Detroit

Hour

Minute

Second

AM PM

Date of Departure

MM

DD

YYYY

Time of departure from Detroit (if flying)

Hour

Minute

Second

AM PM

Waiver *

I will not hold Capoeira International CDO Mangalot LLC responsible for injuries of any kind and/or lost/stolen items. I hearby give Capoeira International CDO permission to use, publish and copyright photographs and/or video of the undersigned without compensation. The undersigned hereby states that I understand that participating in music, dance or Capoeira class is a potentially hazardous activity. I should not participate in such activity unless I am medically able. I assume all risks associated with participating in such activity including but not limited to falls, contact with other participants, slipping, etc., all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of Capoeira International CDO accepting me into such class or activity, I, for myself and anyone entitled to act on my behalf, do waive and release Capoeira International CDO, its employees, contractors and owners from all claims or liabilities or any kind arising out of my participation in this activity, even though that liability may arise out of negligence or carelessness of the part of the persons or organizations named in this waiver.

I agree