Student Name: {name}
This Agreement, entered into by the instructors Lisa & Sylvain Shank, and the Student named above or Parent/Guardian, each of whom have signed this document, is the sole Agreement of the parties, who hereby agree as follows:
NOTICE:
**The procedures and exercises involved and required for teaching and learning karate and self defense have been clearly explained to the student. By signing this agreement, the student and any parent or legal guardian of the student is minor, agree that he/she/they will hold the instructor harmless from any and all losses arising from injury or accident during instruction, and from routine practice with other students. By my signature below and in consideration for the opportunity to attend classes in and engage in the study of the martial arts, I hereby assume all responsibility for any and all risk, damages, injury or loss that I may sustain or incur, if any, while participating in any classes, seminars, events, studies, practices, promotions, or any other instance where I may attempt to study, participate in, or otherwise use the knowledge or techniques taught or demonstrated during same. I agree to absolve and hold harmless, and will waive all claims against, the Matsunoki Martial Arts & Fitness Center, LLC Lisa & Sylvain Shank (dojo owners), any class instructor, or any associate or representative of any of the forgoing or any owners or leaseholders or any real estate where I may be participating in these activities. I will protect and indemnify same against any claims from third parties arising from attempted or actual application or use of any knowledge or techniques taught or learned including, but not limited to, any damages claimed or legal fees incurred by the forgoing persons associated with such a claim. I understand that because participation in the study and practice of martial arts are activities in which I choose to engage, (including, but not limited to, any activities regarding: any Matsunoki Martial Arts & Fitness Center class procedures, breaking demonstration, promotions, sparring, makiwara, physical conditioning, or other activities associated with the events described herein), my participation constitutes my acceptance of the risks inherent in such activities including, bodily injury, death, property damage, and any and all other risks.
The student has been informed of the need for good physical condition and general health for participation in the course of instruction for karate and self defense. The student (and any parent or legal guardian) certifies by signature that the student is in good physical condition and has the approval of his/her physician to participate in heavy physical exercise.
I assert that I have accident/health insurance coverage that will apply in the event of injury as a result of my participation. I consent to and will permit emergency treatment if required, but acknowledge that any such treatment provided by anyone will be on a first-aid basis only. I assert that I am of legal age to contact or that my legal guardian has read and signed this agreement. I give my permission to use my name, voice and likeness, or any recordings, photographs, or other materials for promotion, braodcast, publicity or reproduction, with respect to these martial arts activities, and I waive any compensation in regard thereto.
The Student and any Parent or Legal Guardian, if the student is a minor, have read this entire agreement and hereby accept such agreement in its entirely.
Matsunoki Martial Arts
