Beikoku Shidokan Membership Application

Membership Application & Waiver

Complete all the fields below and agree to the liability waiver to apply for membership to the Beikoku Shidokan Karatedo Association.
First Name
Last Name
QuickBooks Display Name
Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry
E-mail
example@example.com
Phone
Format: (000) 000-0000.
Home Dojo
Birthdate

MonthDayYear
Date
Select Your Membership

Select your membership term and start year below.
We offer 3 membership terms/durations at the price points below. Memberships are based on calendar year, so all memberships begin on Jan. 1 and expire on Dec. 31 regardless of when in the year you purchase them. There are no prorations if you purchase your membership mid-year.
- 1 Year membership: $30
- 3 Year membership: $80
- 5 Year membership: $120
Membership Term
Membership Term Beginning Year
Membership years run from Jan. 1 - Dec. 31
Liability Waiver and Media Release

Please read carefully before indicating your agreement through your e-signature below.
Release and Waiver of Liability and Indemnity Agreement

In consideration of being permitted to participate in any way in the Martial Arts Program indicated below and / or being permitted to enter for any purpose any restricted area (here in defined as any area where in admittance to the general public is prohibited), the participant or parent(s) and / or legal Guardians of the minor participant named below agree:
1. I will not hold Beikoku Shidokan Karatedo Association (BSKA), its employees or volunteers liable or responsible for any viral, germ, bacteria or infectious disease I may contract, including covid-19.
2. Prior to participating in the below martial arts activity or event, the student (adult or youth) should inspect the facilities and equipment to be used, and if he or she believes anything is unsafe, the participant should immediately advise the officials of such condition and refuse to participate. I understand and agree that, if at any time, I feel anything to be UNSAFE; I will immediately take all precautions to avoid the unsafe area and REFUSE TO PARTICIPATE further. If the student is a minor, the parent(s) and / or legal Guardians will instruct & assist the minor participant of the above listed procedure.
3. I / We fully understand and acknowledge that:
  1. There are risks and dangers associated with participation in martial arts events and activities which could result in bodily injury partially and / or total disability, paralysis and death.
  2. The social and economic losses and / or damages, which could result from these risks and dangers described above, could be severe.
  3. These risks and dangers may be caused by the action, inaction or negligence of the participant or the action, inaction or negligence of others, including, but not limited to, the Releasees named below.
  4. There may be other risks not known to us or are not reasonably foreseeable at this time.
4. I / We accept and assume such risks and responsibility for the losses and / or damages following such injury, disability, paralysis or death, however caused and whether caused in whole or in part by the negligence of the Releasees named below.
5. I / We HEREBY RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE the martial arts facility used by the participant, including it’s owners, managers, promoters, lessees of premises used to conduct the martial arts event or program, premises and event inspectors, underwriters, consultants and others who give recommendations, directions or instructions to engage in risk evaluation or loss control activities regarding the martial arts facility or events held at such facility and each of them, their directors, officers, agents, employees, all for the purpose herein referred to as “Releasee”, from all liability to the undersigned, my / our personal representatives, assigns, executors, heirs and next of kin for any and all claims, demands, losses or damages and any claims or demands therefore on account of any injury of any nature, including but not limited to the death of the participant or damage to property, arising out of or relating to the event(s) caused or alleged to be caused in whole or in part by the negligence of the releases, or any other person on the premises.
6. I / We HEREBY acknowledge that THE ACTIVITIES OF THE EVENT(S) ARE VERY DANGEROUS and involve the risk of serious injury and / or death and / or property damage. Each of THE UNDERSIGNED also expressly acknowledges that INJURIES RECEIVED MAY BE COMPOUNDED OR INCREASED BY NEGLIGENT RESCUE OPERATIONS OR PROCEDURES OF THE RELEASEES.
7. Each of the undersigned further expressly agrees that the foregoing release, waiver, and indemnity agreement is intended to be as broad and inclusive as is permitted by the law of the Province or State in which the event is conducted and that if any portion is held invalid, it is agreed that the balance shall, not withstanding continue in full legal force and effect.
8. On behalf of the participant and individually, the undersigned parent(s) and / or legal guardians for the minor participant executes the Waiver and Release. If, despite the release, the participant makes a claim against any of the Releasees, the parent(s) and or legal guardian(s) will reimburse the Releasee for any money which they have paid to the participant, or on his behalf, and hold them harmless.
Media Recording Release

I understand and acknowledge that video recording or photographs may be taken of me during classes/training. I hereby grant BSKA the unlimited use of my likeness in any format – photo, video, or other – for promotional advertisement or commercial use in any format known or yet to be developed in perpetuity, and I forfeit any form of payment.
Consent

I have read both the Release and Waiver of Liability and Indemnity Agreement and Media Recording Release, fully understand its terms, understand that I have given up substantial rights by signing it, and have signed it freely and voluntarily without any inducement, assurance, or guarantee being made to me and intend my e-signature to be complete and unconditional release of all liability to the greatest extent allowed by law. I certify that I am age 18 or over OR the signature is that of a legal parent or guardian.
Electronic Signature
Signing your name signifies your agreement to Release and Waiver of Liability and Indemnity Agreement and the Media Recording Release, its terms, and conditions. This electronic signature is legally binding and equivalent to a handwritten signature. I certify that I am age 18 or over OR the signature above is that of a legal parent or guardian.
Signature Date

MonthDayYear
Date
You will receive an invoice from Beikoku Shidokan via Quickbooks email to pay for your selected membership.
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Membership Application & Waiver

Select Your Membership

Liability Waiver and Media Release