The student or the parent/guardian of the student must complete this form if the student is less than 18 years of age. The responsible party must read, agree to, and sign the agreement and a separate Waiver and Release form for each individual student participating in the program, before you are able to participate in any classes at Southern Indiana Martial Arts, LLC.
LIABILITY WAIVER/ RELEASE AGREEMENT
Participation is possible only if the participant accepts and signs the following waiver of liability, which releases the Southern Indiana Martial Arts, LLC, its owner, instructor(s), and agents from all liability both criminal and civil.
Applicant affirms that he/she is in good physical condition and mental health and is aware that all activities, especially those with regard to actual physical training in the martial arts, are entirely voluntary, and any member can at any time elect not to partake in any activity which he/she feels may involve some element of risk or discomfort to his/her person. Accordingly, the applicant accepts all conditions of membership and agrees to hold Jason Dempster, Southern Indiana Martial Arts, LLC, the school’s affiliated venue, and all other instructors and members harmless from liability for damages or any injuries, including but not limited to death and disability, arising from any of the activities of the school. I also understand that any treatment for injuries sustained will be of a first aid type only, given with my permission.
I know there are risks involved in such activities and that unanticipated risks may arise during such activities. The use of the equipment, facilities, and premises shall constitute acceptance of that risk regardless of the nature of the injury or medical condition. I recognize that dues are non-refundable, even upon injury or illness.
To maintain a safe environment and health-conscientious training, I will observe all school rules and safety guidelines and endeavor to use common sense at all times during my participation.
The terms of this agreement will serve as a release and indemnity agreement for my heirs, personal representative, and for all members of my family, including any minors.
I further state that I am eighteen (18) years of age or older and legally competent to sign this release that I understand these terms are contractual and not mere recital, and that I have signed this document as my own free act. (A parent or legal guardian must sign for all persons under eighteen (18) years of age.)
I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS RELEASE AND INDEMNITY BYREADING IT BEFORE I SIGNED IT.
Initial:
Photo/Video Release
On occasion Southern Indiana Martial Arts, LLC may use literature, photos and video to promote the school to the general public. I understand that I will not receive compensation in any form from the use of my photograph or my photographic likeness and recorded voice.
I hereby consent to the use of my name, photograph, photographic likeness, recorded voice and/or image in video that may appear in any publications, promotional posters, flyers, brochures, printed and electronic ads or electronic media, in addition to the Southern Indiana Martial Arts, LLC website.
Initial:
Southern Indiana Martial Arts