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The undersigned understands that the martial arts offered at Kikunaga Martial Arts, Jiu-Jitsu is a contact martial art involving strenuous exercise and weapons training. The undersigned further acknowledges that Kikunaga Martial Arts (the martial arts school) provides no guarantee of any kind against injuries to any of its students. In consideration of acceptance as a student of Kikunaga Martial Arts Institute, receipt of instruction, the use of the school's facilities and equipment (collectively school activities), the undersigned hereby irrevocably declares that the undersigned personally assumes all responsibility concerning all risks of injury, illness, disability, death or property damage, that the undersigned may incur or be caused to the undersigned while on the school's premises and/or selected exterior training locations.

The undersigned covenants and agrees to indemnify and save harmless Kikunaga Martial Arts, its owner Andre Kikunaga and all employees from any loss or damage suffered by the undersigned on behalf of (where applicable) the undersigned, his/her heirs, executors, administrators and assigns, hereby release, acquit, remise and forever discharge Kikunaga Martial Arts and its owner Andre Kikunaga, each of of its subsidiaries, associated and/or affiliated companies and any of its successors, assigns, affiliates, divisions, predecessors, agents, servants, employees, officers, directors, instructors, students, representatives and each of them (collectively the ''Releasees) the of and from any and all manner of actions, causes of action, proceedings suits, debts, dues, duties, accounts, bonds, covenants, contracts, claims and demands of every kind, known or unknown, whatsoever which against the said Releasees the undersigned now has, ever had or hereinafter can, shall or may have for or by reason of any cause, matter or thing whatsoever and, without limiting the generality of the foregoing, arising out of or in any way related to Kikunaga Martial Arts activities. 

ASSUMPTION OF RISK, RELEASE, WAIVER, CONSENT AND INDEMNITY

I hereby agree that my participation or the participation of the child named below in any practices, training, games, events, programs and/or activities organized, operated, conducted or sanctioned by Kikunaga Martial Arts:

• THAT THE World Health Organization has classified the Coronavirus Disease (“COVID-19”) outbreak as a global pandemic and I am aware of the risks of COVID-19, and the risks to personal health.

• THAT I AM assuming all health risks and adverse health related consequences, including without limitation COVID-19, to me and the child named below caused by or arising from engaging in any Kikunaga Martial Arts' programs (the “Assumed Risks”);

• THAT I AM aware of the Covid Guidelines, that I and the child named below will abide by the Covid Guidelines, and that the Covid Guidelines are subject to all federal, provincial and municipal laws, regulations, by-laws and orders as they may exist from time to time;

• TO RELEASE Kikunaga Martial Arts, owner Andre Kikunaga, event organization bodies, sanctioning bodies and Kikunaga Martial Arts sponsors and their respective directors, officers, employees, agents, volunteers, contractors, representatives, successors or assigns (collectively the “Releasees”) from any liability for any loss, damage, injury or expense (collectively “Loss”) that I may suffer arising out of or connected with the Assumed Risks and/or the content or implementation of Covid Guidelines and/or my participation due to any cause, including negligence;

• TO WAIVE ANY CLAIM that I have or may have against any or all of the Releasees regarding any matter, including without limitation, any claim arising out of any Kikunaga Martial Arts' program or implementation of Covid Guidelines;

• TO INDEMNIFY THE RELEASEES from any and all claims, actions or Loss resulting in any way from my participation or participation of the child named below in any Kikunaga Martial Arts' program or from implementation of Covid Guidelines;

• THAT I am (or the child named below is) physically fit to participate in any Kikunaga Martial Arts' programs;

• THAT I am a legal guardian or custodial parent of the child named below;

• THAT Kikunaga Martial Arts is authorized to record personal information, images and audio recordings in any medium of the child named below or me at or in relation to any Kikunaga Martial Arts' program for publicity and promotional purposes or regarding the implementation of Covid Guidelines, and I hereby consent to the collection, use and disclosure of such personal information about me and/or the child named below;

• TO COMPLY with Covid Guidelines and its implementation and that any failure by me or the child named below to comply with Covid Guidelines or any other Kikunaga Martial Arts rule or guideline may have consequences (including without limitation a withdrawal of permission to participate in any Kikunaga Martial Arts' program).

• THIS DOCUMENT SHALL bind my heirs, executors, administrators, assigns and personal representatives and will have effect throughout my training to the extent reasonably necessary to give it effect, thereafter; BY SUBMITTING THIS APPLICATION, I acknowledge having read the above Assumption of Risk, Release, Waiver, Consent and Indemnity, and that I understand and agree to the above Assumption of Risk, Release, Waiver, Consent and Indemnity.

The undersigned has read and accepts the foregoing. 




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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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