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Participant Information and Waiver
Name of Parent/Guardian if Participant is a Minor
Date of Birth
I declare that the info I’ve provided is accurate & complete
ASSUMPTION AND ACKNOWLEDGMENT OF RISKS RELEASE OF LIABILITY AND INDEMNITY AGREEMENT I hereby represent that, for myself and any minor children for whom I am parent, the student is physically fit to take the prescribed martial arts course of instruction. In consideration of being allowed to participate in martial arts training and activities, for myself and any minor children for whom I am parent, legal guardian or otherwise responsible, and for my/our heirs, personal representatives or assigns;1.) ACKNOWLEDGMENT OF RISKS. I acknowledge that MARTIAL ARTS ACTIVITIES CAN BE VERY DANGEROUS and involve the risk of SERIOUS INJURY and/or DEATH. Risks include, but are not limited to contact with other students during sparring and self-defense exercises, contact with wood or other materials during board-breaking, slips, and falls, all of which can cause serious injury, paralysis and/or death.2.) PHYSICAL CONTACT. I understand that, during the course of instruction, members of the Valley Karate, LLC Martial Arts staff, other students and/or other authorized persons will be engaged in a course of conduct requiring PHYSICAL CONTACT. I give my full consent to such contact as is required by the training.3.) EXPRESS ASSUMPTION OF RISK AND RESPONSIBILITY. I agree to assume responsibility for all the risks of the activity, whether above or not, EVEN THOSE RISKS ARISING OUT OF THE NEGLIGENCE OF THE RELEASEES NAMED BELOW. My/our participation in the activity is purely voluntary. I assume full responsibility for myself and any minor children for whom I am responsible, for any bodily injury, accident, illness, paralysis, death or loss of personal property even IF CAUSED, IN WHOLE OR IN PART, BY THE NEGLIGENCE OF THE RELEASEES NAMED BELOW, to the fullest extent permitted by law.4.) RELEASE. I hereby release Valley Karate, LLC, its principals, directors, officers, agents, employees and volunteers, and each and every landowner, municipal and/or governmental agency upon whose property an activity is conducted (''owner''), if any, (Collectively ''Releasees'') FROM ANY AND ALL LIABILITY OF ANY NATURE FOR ANY AND ALL INJURY OR DAMAGE (INCLUDING DEATH) TO ME OR MY MINOR CHILDREN OR ANY OTHER PERSONS as a result of my/our participation in the activity, EVEN IF CAUSED BY THE NEGLIGENCE OF ANY OF THE RELEASEES NAMED ABOVE OR ANY OTHER PERSON (INCLUDING MYSELF) to the fullest extent permitted by law.5.) INDEMNITY. I hereby agree to INDEMNIFY AND SAVE AND HOLD HARMLESS the Releasees and each of them FROM ANY LOSS, LIABILITY, DAMAGE OR COST they may incur arising out of or related to my participation in any martial arts, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE. I HAVE READ THIS ASSUMPTION AND ACKNOWLEDGMENT OF RISKS, RELEASE OF LIABILITY, AND INDEMNITY AGREEMENT. I UNDERSTAND THAT BY ACCEPTING THIS DOCUMENT, I AM WAIVING VALUABLE LEGAL RIGHTS, INCLUDING ANY AND ALL RIGHTS I MAY HAVE AGAINST THE RELEASEES, OR THEIR EMPLOYEES, AGENTS, SERVANTS OR ASSIGNS AND INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE AND INDEMNITY TO THE GREATEST EXTENT ALLOWED BY LAW. I CERTIFY I AM 18 YEARS OF AGE OR OLDER AND, IF I AM EXECUTING THIS ON BEHALF OF MY CHILD OR WARD, THE INFORMATION SET FORTH ABOVE PERTAINING TO MY CHILD OR WARD IS TRUE AND COMPLETE.
Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19 The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. Valley Karate, LLC has put in place preventative measures to reduce the spread of COVID-19; however, Valley Karate, LLC cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending Valley Karate, LLC activities could increase your risk and your child(ren)’s risk of contracting COVID-19. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending Valley Karate, LLC event and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at Valley Karate, LLC event may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Valley Karate, LLC volunteers, and program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at Valley Karate, LLC events (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless Valley Karate, LLC , its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of Valley Karate, LLC , its employees, volunteers, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Valley Karate, LLC event.
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