Release Waiver of Liability and Indemnity Agreement
Member Information:
First Name:
Last Name:
Date of Birth:
I understand and recognize that Jiu-Jitsu, Wrestling, Judo, MMA, Boxing, Strength & Conditioning, Yoga, and any other martial arts form not listed is a physically demanding activity and a sport that involves physical contact and risk of physical injury and that is taught using all precautions to avoid any injuries to myself or others. With all precautions made, you release Samurai Arts Academy Chesterville, its agents, employees, that you the member or guardian of member or participant shall indemnify and hold harmless Samurai Arts Academy Chesterville, for all claims and causes of action. I, signing of behalf of myself or as guardian, hereby release and waive, hold harmless, and indemnify Samurai Arts Academy Chesterville, its owners, employees, or agents from legal actions, claims, suits, expenses (medical, or attorney fees).
I understand, on behalf of myself or as guardian of member participating in activities that Samurai Arts Academy Chesterville offers that negligence of any kind either known or foreseen, and with such damages, injury, paralysis, loss, or death results will not show negligence acted upon by Samurai Arts Academy Chesterville.
I understand, agree, and abide that I as the participant, member or guardian of participant and member understand and will not act on any legal action, claim or lawsuits of any kind against Samurai Arts Academy Chesterville as a result of bodily injury, paralysis, and death inside the facility or within 500 yards of facility.
With full knowledge of the aforementioned dangers, both to my person and my property (current and future), and after having these dangers fully explained to myself and/or to my legal guardian.
I, member or guardian of member, giving access and grant Samurai Arts Academy Chesterville, its employees or representatives to take photos of me and my property, and to publish and/or copyright on behalf of Samurai Arts Academy Chesterville. Also, to allow to publish, post, or use photography and videos with or without my name for advertising, illustrations, publishing, or publicity.
I hereby certify and declare that I will release and forever hold free and discharge from any liability Samurai Arts Academy Chesterville and each of their agents, stockholders, directors, officers, employees, and representatives of and from all claims, demands, rights and causes of action of any nature whatsoever which may have or which may hereafter accrue to me, arising from and by reason of any and all bodily or personal injury, damage to property or loss and any consequence thereof, whether known or unknown, seen or unforeseen, resulting from any participant in Samurai Arts Academy Chesterville, their persons and entities mentioned above.
It is further understood that this waiver, release and assumption or risk is forever binding on my heirs or assigns.
My signature on this document is evidence that I know and understand and have had this document explained to me, that I fully understand the dangers that are inherent when participating at Samurai Arts Academy Chesterville I agree to the terms and conditions of this waiver form. I agree to the policies applied for all students of Samurai Arts Academy Chesterville presented at the time of registration and future changes implemented.
Please sign Here to Agree to the terms and conditions of this Waiver Form:
Parent/Guardian Signature if under 18 years of age