I wish to participate in the 2012 Louisiana Mardi Gras Encounter promoted by Capoeira Angola Palmares. I understand that instruction in martial arts and related activities such as CAPOEIRA involve strenuous exercise and personal body contact. As a condition to participate in this event, I assume the risk of all injury to myself; I agree to hold the school, its instructors and agents harmless from any and all liability (including attorney's fees and costs) for all claims, action or damages due to injuries suffered by me or caused to someone else by me, arising out of capoeira and related activities, whether occurring at Capoeira Angola Palmares facilities or other facilities to be use. This Waiver and Assumption of Risk does not apply to claims, actions or damages caused by the gross negligence or intentional act or omission of the Capoeira Angola Palmares. I agree to my image being captured, whether on film, video, or by photograph, during the course of the event.  Further, I agree NOT to film or record any portion of the event without prior approval from the administration.

         I have read the above release and agree entirely with its terms.

Please pay the registration fee through PayPal by clicking on the "Buy Now" button and selecting a pricing option on the confirmation page. If you wish to pay by check, please send to: Donovon Miller, PO Box 153, Vacherie, LA 70090.