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Thank you for joining Dallas Kyokushin Karate

 

 

 

I, _________________________________________ (Student’s NAME), understand that any moneys paid in advance by me for the purpose of receiving instruction, once paid are not refundable. I consent that any pictures furnished by me or any purpose taken of me in connection with Dallas Kyokushin Karate  (hereafter, “DKK”) can be used for publicity, promotion or television showing, and waive compensation in regard thereto. I understand that DKK reserves the right to terminate or suspend my membership, without recompense, for reasons of unacceptable behavior or unreasonable length of absence to be determined by said corporation at its sole discretion. I solemnly swear that I am a law-abiding citizen and that at no time shall I ever use the techniques of karate or self-defense in a manner that will inflict personal injury or bodily harm to anyone, except in cases of emergency needs whereby my life and safety, or the lives and physical safety of others may depend upon my knowledge and application of these techniques. I will not be under the influence of drugs or alcohol at the time of any training session or other participation in karate. *Furthermore, for myself, my spouse, legal representatives, heirs and assigns, hereby release, waive and forever discharge DKK, its officers, staff, interns and fellow members (collectively, the "Releasees") from any and all claim, demand, action or right of action, of whatever kind of nature, either in law or in equity, for damages for death, personal injury or property damage which I may have, or which may subsequently accrue to me, arising out of or connected in any way with my participation in the karate program at DKK, whether caused by the negligence of DKK or otherwise. I further release the Releasees from any claim whatsoever on account of first aid, treatment or services rendered to me during my participation in the karate program at DKK. I further understand that serious accidents occasionally occur in the sport of karate, and that persons engaging in karate occasionally sustain mortal or serious personal injuries and/or property damage as a consequence thereof. Knowing the risks of karate, nevertheless, I hereby agree to assume those risks and to release and hold harmless the Releasees who, through negligence or otherwise, might be liable to me, my spouse, legal representatives, heirs and assigns for damages. I expressly agree that the provisions of this release, waiver and indemnity are contractual (and not a mere recital) and are intended to be as broad and inclusive as permitted by the laws of the TEXAS, USA, and that if any portion thereof is held invalid, it is agreed that the remaining provisions shall, notwithstanding, continue in full legal force and effect. This waiver, release and assumption of risk is to be binding on my heirs and assigns.  

COVID 19

I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing. I further acknowledge that Jung Sim Do Martial Art, Inc. has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19. I further acknowledge that Dallas Kyokushin Karate and its instructors can not guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, academy staff, and other academy clients and their families. I voluntarily seek services provided by Dallas Kyokushin Karate and its instructors and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment. I attest that: * I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell. * I have not traveled internationally within the last 14 days. * I have not traveled to a highly impacted area within the United States of America in the last 14 days. * I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19. * I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non-contagious by state or local public health authorities. * I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19. I hereby release and agree to hold Dallas Kyokushin Karate harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the academy, or that may otherwise arise in any way in connection with any services received from Dallas Kyokushin Karate. I understand that this release discharges  Dallas Kyokushin Karate and its instructors from any liability or claim that I, my heirs, or any personal representatives may have against the academy with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Dallas Kyokushin Karate This liability waiver and release extends to the academy together with all owners, partners, instructors, and employees.

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*
Parent or Guardian's Email Address

Email*

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

Relationship*

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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