I, the undersigned, acknowledge that I am applying for instruction in a martial art involving strenuous exercise and personal body contact. I understand that because of the nature of the instruction for which I am applying, there is always an inherent risk of injury, illness or death that cannot be eliminated. I hereby assume full responsibility and liability for all damages, injuries and losses of any kind that I may sustain or incur while participating in or watching any classes, training or competition related to the martial art for which I am applying.
By completing this application and agreeing to participate in activities related to the martial art for which I am applying, I realize that serious injury, even death, is a very real possibility. I also realize that if I am injured, I might be disfigured, disabled, and / or rendered unable to work again. I further realize and understand that participating in activities related to the martial art could, due to the close personal contact required in the martial art, result in me contracting a sickness, disease or a condition that negatively impacts my health (either mental or physical). I also realize and understand that liability may arise from negligence or carelessness on the part of the persons or entities being released, by the result of a training partner's or opponent's actions, my own actions and/or health, the action or inaction of an instructor or staff member, the condition of the facility, the conduct of a non-participant or some other reason not included herein. I further understand and realize that regardless of how the above described potential consequences may occur by entering into this agreement I accept and assume any and all risks associated with the instruction and practice of martial arts. I understand that Munson Karate Institute of America, LLC (including but not limited to its officers, directors, representatives, shareholders, owners, employees, agents, students, instructors, guest instructors, seminar hosts/instructors, staff members, and/or operators), and any other individual(s) instructing the martial art and/or participating in the martial art with me or in close proximity to me, do not maintain insurance against injury, sickness or death to/for any individual participating in the martial art.
In consideration of my request and permitting me to participate in the martial art, I: (a) hereby waive, give up, release, and discharge from any and all claims and liability for any personal injury, death, sickness, disease, disability, health condition, damage, property damage, property theft or actions of any kind regardless of its nature, effect or affect on me which I, or anyone acting on my behalf or through me (including my executors, administrators, heirs, next of kin, successors, and assigns), may have against Munson Karate Institute of America, LLC (including but not limited to its officers, directors, representatives, shareholders, owners, employees, agents, students, instructors, guest instructors, seminar hosts/instructors, staff members, and/or operators), and any other individual(s) instructing the martial art and/or participating in the martial art with me or in close proximity to me due to and/or arising out of my participation, activities and/or involvement in the martial art or any variation thereof, whether occurring on the premises occupied by Munson Karate Institute of America, LLC, or elsewhere; (b) indemnify and hold harmless the persons and entities mentioned in the above paragraphs from any and all liabilities or claims made by other individuals or entities as a result of my actions while participating and/or watching the martial art.
I certify that I am physically fit, am in good health and of sound body and mind, and have not been advised otherwise by a qualified medical person that I cannot participate in the martial art. I represent that I am not presently, nor will I participate while under the influence of any drug or medication. I also represent that no one affiliated with Munson Karate Institute of America, LLC (including but not limited to its officers, directors, representatives, shareholders, owners, employees, agents, students, instructors, guest instructors, seminar hosts/instructors, staff members, and/or operators), and any other individual(s) instructing the martial art has made any representations regarding my fitness or ability to participate.
This Waiver Release and Assumption of Liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.
I certify that I have read and understood every provision of this Waiver Release and Assumption of Liability and that I am legally competent to freely enter into this waiver, release and assumption of risk agreement.
Name: {name}
Date: {sign_date}
Parent or Guardian:
Munson Karate Institute