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WAIVER: Introduction to Boxing + Zen (2024/07/26)

In consideration of acceptance of this application for registration to participate in training and related activities, I for myself, my heirs, assignees, personal representatives, and anyone entitled to act on my behalf, hereby waive and forever release any and all claims, demands and actions for injuries, damages, losses, expenses and fees that I have or may have against Daihonzan Chozen-ji/International Zen Dojo, Aboro Academy, Gopa Boxing Club and their respective officers, directors, employees, agents, assignees, sponsors and volunteers arising out of my participation in training or related activities, and/or arising out of any act or failure to act by Daihonzan Chozen-ji/International Zen Dojo, Aboro Academy, Gopa Boxing Club and their respective officers, directors, employees, agents, assignees, sponsors and volunteers.

I assume the risk of any and all such injuries, damages, losses, expenses and fees, and hereby agree to indemnify, defend and hold harmless Daihonzan Chozen-ji/International Zen Dojo, Aboro Academy, Gopa Boxing Club and their respective officers, directors, employees, agents, assignees, sponsors and volunteers from any and all such injuries, damages, losses, expenses and fees.

I am physically fit and I have been advised by a physician that I may participate in all activities required in training and related activities.

I have read this Release. I understand all of its terms and execute it voluntarily and with full understanding of its significance.

If the applicant is a minor, the parent or guardian submitting this online form executes this Release on behalf of said minor.

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

Email*

Confirm Email*
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.
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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