Isshindo Martial Arts Registration & Liability Waiver Form

Isshindo Martial Arts

Registration Form and Liability Waiver
Student Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

City

Zip Code
Date of Birth*

MonthDayYear
Date
Cell Phone*

Area CodePhone Number
Parent/Guardian (EMERGENCY CONTACT)*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
I'm interested in:*

Brazilian Jiu-JitsuKarateKickboxing
Choose all that apply and specify detail below

InjuriesIllnesses & SurgeryAllergies & Medications taken regularlyOther
Type a label
WAIVER, RELEASE OF LIABILITY, ASSUMPTION OF RISK

IMPORTANT: THIS IS A LEGAL DOCUMENT

From time to time injuries do occur while practising Isshindo. I realized that there are inherent dangers associated with the practice of Isshindo, and in consideration of being allowed to enroll in this school, and in signing this document, I hereby agree to assume full responsibility for any injury received, whether it be due to a fault of my own or as a result of a fault on the part of any of the instructors or other students. I further agree to assume the risk of any adverse effects to my health as a result of my Isshindo training.

I agree not to seek recovery, or compensation from the Cloverdale Isshindo Martial Arts Federation of Canada, the School or from any of the instructors or students for any iniury or loss which I may suffer, during, or as a result of any practice of Isshindo and hereby waiver, release, discharge and agree to save and hold harmless the Cloverdale Isshindo Martial Arts Federation of Canada, the School and its instructors and students from any and all actions, writs, and claims arising out of said instruction. I hereby agree not to sue the Cloverdale Isshindo Martial Arts Federation of Canada, the School, or its instructors or students, for any damages, loss or injury, whether foreseen or unforeseen. I further agree that this document may be pleaded as a defence to any such claim or other proceeding brought by me, my legal representatives, heirs and assigns, and I do hereby intend to bind my legal representatives, heirs and assigns.

I hereby warrant that I am in good health and know of no medical reason that would preclude me from partaking in Isshindo lessons.

I, the undersigned consent that my image or images, obtained during my training with the Cloverdale Isshindo Martial Arts Federation may be reproduced without compensation to me, in whole or in part, in any form of media communication, including but not limited to television, print, video tape, film radio and internet, now or in the future.

I agree that this agreement shall be governed by the laws of British Columbia, Canada.
Student Signature (If Student is a minor, Legal parent or Guardian must sign)*

Powered by Jotform SignClear
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Signature*

Powered by Jotform SignClear
Relationship to Student*
Date*

MonthDayYear
Date
Should be Empty: