Loading...

Family Karate 1 Week Trial Waiver

 

ALL PARTICIPANTS ARE REQUIRED TO COMPLETE AND SIGN THIS PERMISSION SLIP TO ATTEND ANY FAMILY KARATE EVENT AT THE DOJO/SCHOOL and forms an Addendum to any existing contract.  

I HEREBY RELEASE FAMILY KARATE CENTRES, JOHN MARSHALL, AND ANY PERSONS ASSOCIATED WITH THIS EVENT IN ANY CAPACITY FROM ANY AND ALL LIABILITY DUE TO INJURY THAT MAY RESULT IN PARTICIPATION OF THIS EVENT. I CLEARLY UNDERSTAND THE PHYSICAL ASPECTS OF THIS SPORT AND AGREE TO ABIDE BY THE RULES ASSOCIATED WITH THIS EVENT AND ASSUME ALL RESPONSIBILITY AND LIABILITY FOR INFRINGEMENT OF SUCH RULES. I UNDERSTAND THE ENVIRONMENT WILL ONLY ALLOW A LIMITED NUMBER OF STUDENTS FOR THE CLASS AND I WILL ATTEND AT THE TIME INDICATED. THE CLASS WILL RUN FOR 45 MINUTES - I WILL ARRIVE DRESSED AND READY FOR MY SPOT. I ALSO UNDERSTAND THE POSSIBILITY OF BEING EXPOSED TO COVID-19 AND ABSOLVE ALL FROM ANY LEGAL ACTION SHOULD I CONTRACT COVID-19. THE SCHOOL WILL SANITIZE THE WORKOUT AREA AHEAD OF THE NEXT CLASS.  I WARRANT THAT I AM OF SOUND HEALTH AND DO NOT SUFFER FROM ANY AILMENTS THAT I HAVE NOT MADE MENTION OF WITHIN THIS DOCUMENT.

Furthermore, the novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, provincial, and local governments and federal, provincial and local health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. We live in changing times and other contagions may be identified over subsequent months. John Marshall, and/or Family Karate Centres, as well as any staff or employees (“the School”) has put in place preventative measures to reduce the spread of COVID-19 and/or any other infectious risk; however, the School cannot guarantee that you or your child(ren) will not become infected with COVID-19 and/or any other infectious risk. Further, attending the School could increase your risk and your child(ren)’s risk of contracting COVID-19 and/or any other infectious risk. By signing this agreement, I acknowledge the contagious nature of COVID-19 and/or any other infectious risk and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 and/or any other infectious risk by attending the School and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 and/or any other infectious risk at the School may result from the actions, omissions, or negligence of myself and others, including, but not limited to, School employees, volunteers, and program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at the School or participation in School programming (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless the School, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the School, its employees, agents, and representatives, whether a COVID-19 and/or any other infectious risk where said infection occurs before, during, or after participation in any School program. 

Based on the Ministry of Health from the Government of Ontario and Middlesex-London Health Unit have provided recommendations and directives, and based on these exchanges, we reserve the right to alter the class delivery and/or curriculum content to comply and provide the safest environment possible. Also based on specific recommendations, and for the safety of all involved, only one parent is allowed to stay with a student signed up and attending a Private Lesson, a Little Dragon's class or a White Belt class only - All other classes will be student drop-off only. The student will be checked in at the double doors after entering the vestibule. As reported in the news, PPE/Masks are extremely difficult to obtain at this time throughout the country. As directed by the the Ministry of Health from the Government of Ontario and Middlesex-London Health Unit, all students, visitors and instructors will need to wear a brand-new provided mask at each visit. There will be no initial cover charge for your needed mask during the first two weeks of class. The student, and parent if attending, will be supplied a new mask to wear while on premises. For the safety of all, no reusable masks from home will be permitted. A no-touch temperature reading will be taken when the student arrives by counter staff and they will identify the mat location the student has been assigned for your class. After the initial first two weeks of June, masks may become optional and home use masks may be acceptable. The Health Unit will guide any changes. We appreciate your understanding as we navigate the return to the dojo in the safest manner possible.    

Today's Date: July 3, 2020

 

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information

Age *
Select your one week Trial in: *
Karate
Kali Silat (Self-Defense)
Traditional Uechi
Cardio Kick

The location of the event will be Sherwood Forest Mall (1225 Wonderland Road N) and/or On-line as dictated by government directives. 


Medical Concerns (If Any)

Home Address: *

City: *

Province: *

Postal Code: *

Trial Start Date: *
Tell us how you found out about this trial offer please...*

List any other Information to help us determine how you found the trial: (Such as: friend's name, Radio advert, flyer, or Birthday party attended)
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Age *
Select your one week Trial in: *
Karate
Kali Silat (Self-Defense)
Traditional Uechi
Cardio Kick

The location of the event will be Sherwood Forest Mall (1225 Wonderland Road N) and/or On-line as dictated by government directives. 


Medical Concerns (If Any)

Home Address: *

City: *

Province: *

Postal Code: *

Trial Start Date: *
Tell us how you found out about this trial offer please...*

List any other Information to help us determine how you found the trial: (Such as: friend's name, Radio advert, flyer, or Birthday party attended)
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

Age *
Select your one week Trial in: *
Karate
Kali Silat (Self-Defense)
Traditional Uechi
Cardio Kick

The location of the event will be Sherwood Forest Mall (1225 Wonderland Road N) and/or On-line as dictated by government directives. 


Medical Concerns (If Any)

Home Address: *

City: *

Province: *

Postal Code: *

Trial Start Date: *
Tell us how you found out about this trial offer please...*

List any other Information to help us determine how you found the trial: (Such as: friend's name, Radio advert, flyer, or Birthday party attended)
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Age *
Select your one week Trial in: *
Karate
Kali Silat (Self-Defense)
Traditional Uechi
Cardio Kick

The location of the event will be Sherwood Forest Mall (1225 Wonderland Road N) and/or On-line as dictated by government directives. 


Medical Concerns (If Any)

Home Address: *

City: *

Province: *

Postal Code: *

Trial Start Date: *
Tell us how you found out about this trial offer please...*

List any other Information to help us determine how you found the trial: (Such as: friend's name, Radio advert, flyer, or Birthday party attended)
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Age *
Select your one week Trial in: *
Karate
Kali Silat (Self-Defense)
Traditional Uechi
Cardio Kick

The location of the event will be Sherwood Forest Mall (1225 Wonderland Road N) and/or On-line as dictated by government directives. 


Medical Concerns (If Any)

Home Address: *

City: *

Province: *

Postal Code: *

Trial Start Date: *
Tell us how you found out about this trial offer please...*

List any other Information to help us determine how you found the trial: (Such as: friend's name, Radio advert, flyer, or Birthday party attended)
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Age *
Select your one week Trial in: *
Karate
Kali Silat (Self-Defense)
Traditional Uechi
Cardio Kick

The location of the event will be Sherwood Forest Mall (1225 Wonderland Road N) and/or On-line as dictated by government directives. 


Medical Concerns (If Any)

Home Address: *

City: *

Province: *

Postal Code: *

Trial Start Date: *
Tell us how you found out about this trial offer please...*

List any other Information to help us determine how you found the trial: (Such as: friend's name, Radio advert, flyer, or Birthday party attended)
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Age *
Select your one week Trial in: *
Karate
Kali Silat (Self-Defense)
Traditional Uechi
Cardio Kick

The location of the event will be Sherwood Forest Mall (1225 Wonderland Road N) and/or On-line as dictated by government directives. 


Medical Concerns (If Any)

Home Address: *

City: *

Province: *

Postal Code: *

Trial Start Date: *
Tell us how you found out about this trial offer please...*

List any other Information to help us determine how you found the trial: (Such as: friend's name, Radio advert, flyer, or Birthday party attended)
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Age *
Select your one week Trial in: *
Karate
Kali Silat (Self-Defense)
Traditional Uechi
Cardio Kick

The location of the event will be Sherwood Forest Mall (1225 Wonderland Road N) and/or On-line as dictated by government directives. 


Medical Concerns (If Any)

Home Address: *

City: *

Province: *

Postal Code: *

Trial Start Date: *
Tell us how you found out about this trial offer please...*

List any other Information to help us determine how you found the trial: (Such as: friend's name, Radio advert, flyer, or Birthday party attended)
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Age *
Select your one week Trial in: *
Karate
Kali Silat (Self-Defense)
Traditional Uechi
Cardio Kick

The location of the event will be Sherwood Forest Mall (1225 Wonderland Road N) and/or On-line as dictated by government directives. 


Medical Concerns (If Any)

Home Address: *

City: *

Province: *

Postal Code: *

Trial Start Date: *
Tell us how you found out about this trial offer please...*

List any other Information to help us determine how you found the trial: (Such as: friend's name, Radio advert, flyer, or Birthday party attended)
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Age *
Select your one week Trial in: *
Karate
Kali Silat (Self-Defense)
Traditional Uechi
Cardio Kick

The location of the event will be Sherwood Forest Mall (1225 Wonderland Road N) and/or On-line as dictated by government directives. 


Medical Concerns (If Any)

Home Address: *

City: *

Province: *

Postal Code: *

Trial Start Date: *
Tell us how you found out about this trial offer please...*

List any other Information to help us determine how you found the trial: (Such as: friend's name, Radio advert, flyer, or Birthday party attended)
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*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Age *
Select your one week Trial in: *
Karate
Kali Silat (Self-Defense)
Traditional Uechi
Cardio Kick

The location of the event will be Sherwood Forest Mall (1225 Wonderland Road N) and/or On-line as dictated by government directives. 


Medical Concerns (If Any)

Home Address: *

City: *

Province: *

Postal Code: *

Trial Start Date: *
Tell us how you found out about this trial offer please...*

List any other Information to help us determine how you found the trial: (Such as: friend's name, Radio advert, flyer, or Birthday party attended)
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver