Roots Dojo

Roots Dojo

Disclaimer & Release of Liability
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
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Email
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Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Emergency Contact Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Acknowledgment of Risks and Responsibility

By signing this form, I, {name}, acknowledge that I am voluntarily participating in training and activities at Roots Dojo. I understand that this is martial arts and that physical training involves inherent risks, including but not limited to falls, collisions, strikes, or other injuries. While safety measures are in place, accidents may occur.

I recognize that participation in martial arts may result in injuries, ranging from minor injuries (such as bruises or sprains) to more serious injuries (such as fractures, concussions, or other significant harm). I accept full responsibility for my own safety and well-being while participating in any activity at Roots Dojo.

I understand that training may involve challenging or strenuous exercises, and I am responsible for making decisions regarding my own limits and comfort. I agree to follow the instructions of my instructors at all times unless I feel unsafe or uncomfortable.

I understand that Roots Dojo does not have insurance.
I have read and understand the Acknowledgment of Risks and Responsibility
Release of Liability

In consideration of being allowed to participate at Roots Dojo, I, {name}, hereby release, discharge, and hold harmless Roots Dojo, Vali Majd, its owner(s), instructors, guest instructors, Coho (Triple Rock Land Cooperative) staff, and other participants from any and all liability, claims, or causes of action that may arise from my participation, including claims resulting from negligence or wrongdoing. I further acknowledge that this release extends to anyone who may seek to take action on my behalf, now or in the future.

This release applies to any injury, illness, or other damages that may occur during or as a result of participation in training or related activities at Roots Dojo.

If I am under 18 years of age, I understand that my parent or legal guardian must also sign this form, acknowledging and consenting to my participation and agreeing to the terms of this release on my behalf.
I have read and understand the Release of Liability
Media Release

I, {name}, understand that photographs, videos, or other recordings may be taken during classes and events at Roots Dojo. I acknowledge that my image, likeness, or other identifying features may be used for promotional, educational, or advertising purposes.
I have read and understand the Media Release
WhatsApp Group Communication Consent

Roots Dojo may use WhatsApp group chats to share updates, announcements, scheduling information, and other relevant communications related to Roots Dojo classes, events, and activities. Participation in these group chats is voluntary.

By checking the box below, you consent to being added to a Roots Dojo WhatsApp group. You understand that messages within the group may be visible to other participants and that Roots Dojo is not responsible for interactions, content, or third-party communications that occur within the group. You may leave the group at any time.
I consent to being added to Roots Dojo WhatsApp group communications.
Acknowledgment and Signature

I, {name}, have read this Disclaimer & Release of Liability, fully understand its terms, and sign it voluntarily. I understand that I am giving up certain legal rights by signing this form.
Participant Name:
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
If Under 18, Legal Guardian Name:

First NameLast Name
Legal Guardian Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
By clicking the button below, I {name} confirm that all information provided is true to the best of my knowledge, and I acknowledge that I have read and understood this Disclaimer & Release of Liability.
Should be Empty:

Acknowledgment of Risks and Responsibility

Release of Liability

Media Release

WhatsApp Group Communication Consent

Acknowledgment and Signature