Waiver of Liability, Consent to Emergency Medical Treatment & to Use of Likeness or Image


I have enrolled in a Martial or Cultural Arts Program of Seichou Karate® Ltd. (SKL) of strenuous physical activity and rigorous cardiovascular exercise that includes, but is not limited to, the practice of indoor, outdoor and online (via the internet) kicking, punching, striking, blocking, walking, hiking, tumbling, falling, flipping and sweeping. I fully understand and agree that the martial arts component of this program is a contact sport requiring participants to kick, punch, strike, flip, throw and sweep, and be kicked, punched, struck, flipped, thrown and swept by other students during sparring (kumite and randori) sessions.

I also acknowledge and agree that participation in activities at SKL’s premises and outdoor events involves other health risks, including but not limited to exposure to and infection with viruses or bacteria, such as flu and Coronavirus (COVID-19), which is an extremely contagious virus that spreads easily through person-to-person contact. Participating in SKL programs or accessing SKL facilities could increase the risk of contracting COVID-19, and SKL in no way warrants that COVID-19 infection will not occur through participation in SKL programs, events or accessing SKL facilities.

In view of this, I understand that I may sustain illness and injury, including death, from participation, and that I must read and adhere to the Seichou Sparring Rules and Safety Guidelines, which are available at www.seichoukarate.com. In view of this, I represent that I am in good physical condition and am not under order of any doctor that would prevent or limit my participation in SKL programs. To the extent that I feel that my participation in these programs might be inadvisable for health reasons, I have consulted a medical doctor.

I hereby release SKL, Carr Workplaces (MC Property LLC), their employees, contractors, instructors, and owners from all liability arising now or in the future including, but not limited to, heart attacks, bodily soreness, muscle strains, pulls or tears, broken bones, shin splints, heat prostration, injuries to the head, knee, lower back, feet, and exposure to and infection with bacteria and viruses, such as COVID-19, HIV/AIDS and other blood or fluid-borne illnesses, or death, however caused, occurring during or after participation in this SKL programs. This release specifically includes claims, demands and causes of action that allege negligent acts or omissions.


In the event of injury, I authorize SKL, to undertake the following emergency procedures on my behalf: (1) administer first aid type treatment, (2) summon medical professionals to attend to me, (3) contact my emergency designee, and (4) transport me to a medical facility of SKL’s choice. I agree that I will be responsible for all costs arising from my treatment.


I understand that the purpose of the martial arts training program that I will undertake is to develop greater mental and physical self-control. I also understand that I must forever refrain from using the martial arts techniques I learn in a violent or criminal manner. I understand and agree to abide by these rules.


I consent to the use of any likeness, photographic, videographic, or digital image taken of me by SKL, its clients and agents for commercial sale or promotional use. I waive any rights that I might have to compensation for the sale or use of such material by SKL.


I understand the nature and extent of the risks inherent in participating in SKL’s cultural and martial arts programs and in using its facilities, and I voluntarily assume those risks. I agree that I will be solely responsible for any loss or damage, including personal injury, property damage or death, I sustain while participating in SKL programs or using its facilities.

I understand that this document is a promise not to sue and a release of and indemnification for all claims. Should SKL, or anyone acting on its behalf, incur attorney’s fees or costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.

In consideration of my participation in SKL programs or access to its facilities, I agree to indemnify and hold harmless SKL, its employees, contractors, instructors and owners from any cause of action, claim, demand, loss, or cost of any nature whatsoever arising out of or in any way related to my program participation or access to SKL facilities.


I have carefully read and voluntarily sign this document and further agree that no oral representations, statements or inducements apart from this written agreement have been made. I am aware that by agreeing to this agreement I am giving up valuable legal rights, including the right to recover damages from SKL, its employees, contractors, instructors and owners.

If signing on behalf of minors, I also understand that this agreement is made on their behalf and on behalf of legal wards I represent. In that case, I warrant to SKL that I have full authority to sign this agreement on their behalf.

I agree that this document shall be interpreted and governed by the laws of the Commonwealth of Virginia. I hereby affirm that I have read, understand and fully assent to the foregoing.

Dated: April 16, 2024

First Participant's Name

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

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

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

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

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

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

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

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

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

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Tenth Participant's Date of Birth*
Parent or Guardian's Email Address


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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.

By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
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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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