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Waiver of Liability and Indemnity Agreement

Photo Release

(Read Carefully Before Signing)

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 parent(s) and/or legal guardian(s) of the minor participant named below agree:

  1. The parent(s) and/or legal guardian(s) will instruct the minor participant that prior to participating in the below martial arts activity or event, he or she 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/WE understand and agree that, if at any time, I/WE feel anything to be UNSAFE; I/WE will immediately take all precautions to avoid the unsafe area and REFUSE TO PARTICIPATE further. 
    a.There are risks and dangers associated with participation in martial arts events and activities which could result in bodily injury partial and/or total disability, paralysis and death.

    b.The social and economic losses and/or damages, which could result from these risks and dangers described above, could be severe.
    c.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.
    d.There may be other risks not known to us or are not reasonably foreseeable at this time.
  2. 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.
  3. I/We HEREBY RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE the martial arts facility used by the participant, including it 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 to kin For any and all claims, demands, losses or damages and any claims or demands therefore on account of any injury, including but not limited to the death of the participant or damage to property, arising out of or relating to the events(s) caused alleged to be caused in whole or in part by the negligence of the releasee or otherwise.
  4. I/WE am in good physical condition and have no disability, illness, or other condition, whether it be physical or emotional, that could prevent me from exercising and practicing without injuring myself or impairing my health.
  5. I /WE have consulted a physician concerning an exercise program that will not risk injury to myself or cause impairment to my health. The medical fact sheet which I have provided is complete and accurate and I agree to provide written updates as necessary.
  6. I/WE understand that practice of techniques taught at Pathway Karate Academy, LLC involves inherent risk of injury to persons and/or property. All participation in training techniques, use of these facilities, services, programs, and premises are undertaken by me at my sole risk, which I hereby assume.
  7. I/WE currently have and agree to maintain health insurance, which extends to any injury sustained while participating in the activities of Pathway Karate Academy, LLC
  8. I/WE further warrant and represent that I have had an opportunity to observe the activities of Pathway Karate Academy, LLC and understand the risks associated with these activities. I voluntarily assume the risks associated with my participation.
  9. I/WE hereby release, hold harmless, and agree to indemnify Pathway Karate Academy, LLC, and or Leckie Mark Anthony Mason and any organization associated with this program from liability caused by my actions in the Pathway Karate Academy, LLC program
  10. I/WE will not hold these entities/people responsible for any claims, demands, injuries, damages, actions, or causes of action whatsoever, to person or property, including, but not limited to, any claim of negligence or gross negligence arising out of, or connected in any manner with, my participation in this program. This includes, among other things, participation in training, the techniques, the use of the facilities, premises, services, or any other program or services offered by the Pathway Karate Academy, LLC
  11. I/WE fully understand and voluntarily consent to the terms and conditions of this agreement and I fully certify that the information provided is accurate and that I will promptly provide written notice of any changes.
  12. I/WE fully understand and agree that Sensei Leckie Mark Anthony Mason or his designated representative has the right to terminate my enrollment in the Pathway Karate Academy, LLC Program, at his/her sole discretion, and/or I determine that my continued attendance in the program is not in my best interest or the best interest of the Pathway Karate Academy program.
  13. 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. On behalf of the participant and individually, the undersigned partners(s) and/or legal guardian(s) for the minor participant executes this Waiver and Release. If, despite the release, the participant makes a claim against any of the Releasees, the parents(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.
  14. 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, notwithstanding continue in full legal force and effect.

    A.I/WE agree to allow Pathway Karate Academy, LLC to use photos or video footage taken of myself, my child, my family and/or any caregiver of my children in the Dojo or at Pathway Karate Academy sponsored events for archival and publicity purposes without prior notice to me and without requiring any additional approval for such use. I expressly waive any right to compensation.

    B.I/WE agree to allow Pathway Karate Academy, LLC to contact me via email and to send information regarding events, special offers and news via email. Pathway Karate Academy, LLC will not distribute your email to any unauthorized 3rd parties without expressed consent.

I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WTHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.

Dated: November 14, 2018

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*

Phone*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*

Phone*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*

Phone*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*

Phone*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*

Phone*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*

Phone*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*

Phone*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*

Phone*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*

Phone*
Tenth Participant's Date of Birth*
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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