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This school, its agents, servants or employees, shall not be responsible or in any way liable to the student, his or her parents, guardians, heirs, executors, administrators, or assigns, for any damages, or redress in any form for any injuries caused to or sustained by the student because of any accident of any kind, whether such accident shall be caused by or arise from its or their negligence or from any cause whatever except that this waiver of liability shall not extend to any such agent, servant or employee who causes any such injury by his willful act. The student or the student’s parents or guardians assume the risk of injury to the student while attending courses or lessons or any activity. The undersigned student or the undersigned parent or guardian of the student, for himself, his heirs, executors and administrators covenants not to sue the school, its agents, servants and employees and shall indemnify and save harmless the school, its agents, servants and employees, against all damage, loss or expense which they or any of them incur as the result of any claim or action which may, at any time, be made or instituted by or on behalf of the undersigned student or his representative including, without being limited to any claim or action based upon negligence of the school, its agents, servants and employees.

NOTICE: THIS IS A LEGALLY BINDING AGREEMENT. Read this document solicit and in entirety. By signing this agreement, you give up your right to bring a court action to recover compensation or obtain any other remedy for any personal injury or property damage however caused arising out of your participation in Aikido Florida Aikikai (“Company”) Company’s Programs now or at any time in the future. 

ASSUMPTION OF RISK I hereby acknowledge and agree that participation in Company fitness activities comes with inherent risks. I have full knowledge and understanding of the inherent risks associated with participation in Company fitness programs and facilities, including but in no way limited to: (1) slips, trips, and falls, (2) aquatic injuries, (3) athletic injuries, and (4) illness, including exposure to and infection with viruses or bacteria. I further acknowledge that the preceding list is not inclusive of all possible risks associated with fitness program participation and facility use and that said list in no way limits the operation of this Agreement. 

CORONAVIRUS / COVID-19 WARNING, DISCLAIMER, AND CUSTOMER WARRANT Coronavirus, COVID-19 is an extremely contagious virus that spreads easily through person-to-person contact. Federal and state authorities recommend social distancing as a mean to prevent the spread of the virus. COVID-19 can lead to severe illness, personal injury, permanent disability, and death. Participating in Company programs or accessing Company facilities could increase the risk of contracting COVID-19. Company in no way warrants that COVID-19 infection will not occur through participation in Company programs of accessing Company facilities. 

The undersigned hereby agrees, represents, and warrants that neither the undersigned nor such participating children shall visit or utilize the facilities, services, and programs of Company (other than any exclusively online services and programs) within 14 days after (i) returning from highly impacted areas subject to a CDC Level 3 Travel Health Notice, (ii) exposure to any person returning from areas subject to a CDC Level 3 Travel Health Notice, or (iii) exposure to any person who has a suspected or confirmed case of COVID-19. The CDC Travel Health Network is continuously updating this list and the undersigned agrees that they are aware of this list and the countries listed. The undersigned agrees to check the CDC Travel Health Notices list prior to utilizing the facilities, services, and programs of Company, on a daily basis if necessary. 

The undersigned hereby agrees, represents, and warrants that neither the undersigned nor such participating children shall visit or utilize the facilities, services, and programs of Company if he or she (i) experiences symptoms of COVID-19, including, without limitation, fever, cough or shortness of breath, or (ii) has a suspected or diagnosed/confirmed case of COVID-19. The undersigned agrees to notify Company immediately if he or she believes that any of the foregoing access/use restrictions may apply. The undersigned acknowledges and assumes both the known and potential dangers of utilizing the facilities, services, and programs of Company and acknowledges that use thereof by the undersigned and/or such participating children may, despite the Company’s reasonable efforts to mitigate such dangers, result in exposure to COVID-19, which could result in quarantine requirements, serious illness, disability, and/or death.

In consideration of my participation in [Florida Aikikai programing], I, the undersigned participant, knowingly and voluntarily agrees to release and on behalf of myself, any participating children, my heirs, representatives, executors, administrators, and assigns, HEREBY DO RELEASE Company, its officers, directors, employees, volunteers, agents, representatives and insurers (“Releasees”) from any causes of action, claims, or demands of any nature whatsoever including, but in no way limited to, claims of negligence, which I, my heirs, representatives, executors, administrators and assigns may have, now or in the future, against Company on account of personal injury, property damage, death or accident of any kind, arising out of or in any way related to the use of Company facilities/equipment or participation in Company programs whether that participation is supervised or unsupervised, however the injury or damage occurs, including, but not limited to the negligence of Releasees. THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR, AND RISK OF ILLNESS, BODILY INJURY, DEATH OR PROPERTY DAMAGE to the undersigned or such participating children due to negligence, active or passive, or otherwise while in, about or upon the premises of Company and/or while using the premises or any facilities or equipment thereon or participating in any program affiliated with Company The undersigned acknowledges that any illness or injuries that the undersigned or such participating children contract or sustain may be compounded by negligent first aid or emergency response of the Releasees and waive any claim in respect thereof. 

In consideration of my participation in Company programing or access to facilities, I, the undersigned participant, agree to INDEMNIFY AND HOLD HARMLESS Releasees from any and all causes of action, claims, demands, losses, or costs of any nature whatsoever arising out of or in any way related to my program participation or access to facilities. I hereby certify that I have full knowledge of the nature and extent of the risks inherent in fitness program participation and facility use and that I am voluntarily assuming said risks. I understand that I will be solely responsible for any loss or damage, including personal injury, property damage, or death, I sustain while participating in Company programing or facility use and that by signing this agreement I HEREBY RELEASE Releasees from all liability for such loss, damage, or death. I further certify that I am in good health and that I have no conditions or impairments which would preclude my safe participation in Company programming or facility use. 

I HAVE CAREFULLY READ AND VOLUNTARILY SIGN THIS ASSUMPTION OF RISK, RELEASE AND WAIVER OF LIABILITY, AND INDEMNITY AGREEMENT AND FURTHER AGREE THAT NO ORAL REPRESENTATIONS, STATEMENTS OR INDUCEMENT APART FROM THE FOREGOING 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 COMPANY IN CASE OF ILLNESS, INJURY, DEATH OR PROPERTY LOSS OR DAMAGE, INCLUDING, FOR THE AVOIDANCE OF DOUBT AND WITHOUT LIMITATION, EXPOSURE TO COVID-19 AT ANY COMPANY FACILITY OR PROGRAM AND ANY ILLNESS, INJURY OR DEATH RESULTING THEREFROM. I UNDERSTAND THAT THIS DOCUMENT IS A PROMISE NOT TO SUE AND A RELEASE OF AND INDEMNIFICATION FOR ALL CLAIMS. IF SIGNING ON BEHALF OF MINOR: I ALSO UNDERSTAND THAT THIS AGREEMENT IS MADE ON BEHALF OF MY MINOR CHILD(REN) AND/OR LEGAL WARDS AND I REPRESENT AND WARRANT TO COMPANY THAT I HAVE FULL AUTHORITY TO SIGN THIS AGREEMENT ON BEHALF OF SUCH MINOR(S). IN WITNESS WHEREOF, this instrument is duly executed this May 13, 2024.

This form must be signed by the student's legal parent or guardian.

First  Name

First Name*

Last Name*

Phone*
First  Date of Birth*
First 
How did you hear about us?*
Please tell us how you are hoping to benefit from this class: *
Learn ways to fall safely
Improve my balance
Decrease my fear about falling
Try Aikido
Other (please describe below)
First  Signature*
Second Name

First Name*

Last Name*
Second Date of Birth*
Second
How did you hear about us?*
Please tell us how you are hoping to benefit from this class: *
Learn ways to fall safely
Improve my balance
Decrease my fear about falling
Try Aikido
Other (please describe below)
Third Name

First Name*

Last Name*
Third Date of Birth*
Third
How did you hear about us?*
Please tell us how you are hoping to benefit from this class: *
Learn ways to fall safely
Improve my balance
Decrease my fear about falling
Try Aikido
Other (please describe below)
Fourth Name

First Name*

Last Name*
Fourth Date of Birth*
Fourth
How did you hear about us?*
Please tell us how you are hoping to benefit from this class: *
Learn ways to fall safely
Improve my balance
Decrease my fear about falling
Try Aikido
Other (please describe below)
Fifth Name

First Name*

Last Name*
Fifth Date of Birth*
Fifth
How did you hear about us?*
Please tell us how you are hoping to benefit from this class: *
Learn ways to fall safely
Improve my balance
Decrease my fear about falling
Try Aikido
Other (please describe below)
Sixth Name

First Name*

Last Name*
Sixth Date of Birth*
Sixth
How did you hear about us?*
Please tell us how you are hoping to benefit from this class: *
Learn ways to fall safely
Improve my balance
Decrease my fear about falling
Try Aikido
Other (please describe below)
Seventh Name

First Name*

Last Name*
Seventh Date of Birth*
Seventh
How did you hear about us?*
Please tell us how you are hoping to benefit from this class: *
Learn ways to fall safely
Improve my balance
Decrease my fear about falling
Try Aikido
Other (please describe below)
Eighth Name

First Name*

Last Name*
Eighth Date of Birth*
Eighth
How did you hear about us?*
Please tell us how you are hoping to benefit from this class: *
Learn ways to fall safely
Improve my balance
Decrease my fear about falling
Try Aikido
Other (please describe below)
Ninth Name

First Name*

Last Name*
Ninth Date of Birth*
Ninth
How did you hear about us?*
Please tell us how you are hoping to benefit from this class: *
Learn ways to fall safely
Improve my balance
Decrease my fear about falling
Try Aikido
Other (please describe below)
Tenth Name

First Name*

Last Name*
Tenth Date of Birth*
Tenth
How did you hear about us?*
Please tell us how you are hoping to benefit from this class: *
Learn ways to fall safely
Improve my balance
Decrease my fear about falling
Try Aikido
Other (please describe below)
Parent or Guardian's Email Address

Email*

Confirm Email*
If you do not wish us to use photos/videos of your child for publicity purposes please check the box
Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Emergency Contact

First Name*

Last 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.


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*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's
How did you hear about us?*
Please tell us how you are hoping to benefit from this class: *
Learn ways to fall safely
Improve my balance
Decrease my fear about falling
Try Aikido
Other (please describe below)
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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