NEW STUDENT APPLICATION
INSTRUCTIONS: Please PRINT and complete ALL sections of the Application. Do not leave blank or write “N/A” if a question is “not applicable.” An incomplete Application will not be accepted. By submitting this Application to Shotokan Karate Center, Inc. (“SKC”), student/applicant acknowledges, agrees and consents that any incomplete or untruthful information provided to SKC with regard to this Application may be grounds for denial of acceptance or subsequent expulsion without any refund of monies paid.
WAIVER OF LIABILITY, HOLD HARMLESS, INDEMNIFICATION and ASSUMPTION OF RISK
In consideration of being allowed to participate in martial arts training at SKC and its related events and activities, I, the undersigned, on behalf of myself, my heirs, next of kin, successors and assigns, do knowingly, voluntarily and intelligently, acknowledge, appreciate and agree that:
1. The risk of injury from participating in martial arts is significant, including the potential for permanent injury, paralysis or death. I, on my own behalf and on behalf of my minor child, knowingly and freely assume all such risks, both known and unknown, and assume full responsibility for my participation. If student observes any unusual significant hazard during participation, student agrees to remove him/herself from participation and immediately bring such to the attention of a SKC instructor or school representative.
2. I understand participation at SKC may be of a hazardous nature and/or include physical and/or strenuous activity. I have no medical condition or impairment that might threaten my health or safety during participation in martial arts training.
3. I understand that neither Shotokan Karate Center, Inc., the Japan Karate Association – American Federation, the Japan Karate Association HQ (the “Covered Parties”), nor any venue used for any event associated with any activity, provide medical insurance coverage for any injury or damages of any kind, and student shall be responsible to provide all applicable medical insurance.
4. I agree SKC is under no duty of care to provide any form of medical care to student in case of injury and student has advised SKC that he/she has sufficient medical insurance to cover any injury. Should SKC elect to administer, or have cause to be administered, whatever first aid or emergency medical care deemed necessary in their sole and exclusive discretion for student’s welfare, it is understood that student and student’s parents, heirs, assigns, personal representatives and next of kin shall fully release and hold the Covered Parties harmless from taking any such action and that student shall be solely and exclusively responsible for any and all charges for such health care services regardless of whether student’s medical insurance would cover such charges.
5. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release, indemnify and hold harmless the Covered Parties and their respective owners, officers, officials, agents, employees, volunteers, and all other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event or activity, harmless with respect to any and all injury, disability, death, or loss or damage to person or property incurred by student or by a third party as a result of student, to the fullest extent permitted by law.
I HAVE READ THIS APPLICATION AND INCLUDED WAIVER OF LIABILITY, HOLD HARMLESS, INDEMNIFICATION AND ASSUMPTION OF RISK, FULLY UNDERSTAND ITS TERMS, AND UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS FOR MYSELF OR MY MINOR CHILD BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
