ACKNOWLEDGEMENT AND RELEASE FORM
I, on behalf of myself, members of my family, my heirs, executors, administrators and assigns assume all responsibility for and all risk of damage or injury that may occur to the undersigned, as a participant or student in Victory Defense Systems, course of instruction in martial arts techniques, body conditioning and self-defense (referred to in this Assumption of Risk Agreement and Release as “Martial Arts Instruction”), while attending classes, participating in exercises, fighting opponents, performing in demonstrations, or using Martial Arts Instruction equipment, weapons and designated Martial Arts Instruction facilities (any location used for the Martial Arts Instruction or demonstrations, hereinafter referred to as “Designated Facilities”) or following Martial Arts Instruction activities in or out of Designated Facilities or traveling to or from any Designated Facilities.
I am aware Martial Arts Instruction is a hazardous activity, and am voluntarily participating in this activity with knowledge of the danger involved and hereby agree to accept any and all risks of injury.
The undersigned releases and discharges Victory Defense Systems and all Designated Facilities along with all of its designated parties, such as, but not limited to: owners, instructors, assistant instructors, other participants or students from all and all claims, demands, damages, rights of action, or causes of action, present or future, whether known or unknown, anticipated or unanticipated, and resulting from or arising out of, or incident to, the undersigned’s use (or intended use) of Martial Arts Instruction, Designated Facilities, equipment and weapons in such place or as a result of, or incident to, engaging in Martial Arts Instruction or otherwise following Martial Arts Instruction anywhere. I currently have no known physical or mental condition that would impair my capability for full participation in Martial Arts Instruction.
The undersigned acknowledges that:
1. He/She is desirous of using, as a member on a membership basis, the academy herein referred to as Victory Defense Systems.
2. He/She has received a completely executed copy of this agreement by printing or viewing this webpage.
3. He/She confirms that there were no verbal presentations other than those specified in this agreement
4. If the student is under the age of eighteen:
a. I hereby certify and represent that I am the legal guardian of the student or participant and I am legally competent to execute this Agreement.
b. I, as a parent or guardian of the student or participant, hereby represent that the facts concerning my child or ward are true and give my permission for my child or ward to participate in martial arts instruction and in such participation, agree individually and on the behalf of my child or ward to the terms of the Agreement.
c. I, as a parent or guardian of the student or participant, authorize the treatment by a qualified and licensed medical doctor of my child or ward in the event of a medical emergency which, in the opinion of the attending physician, may endanger the child’s or ward’s life, cause disfigurement, physical impairment or undue discomfort if treatment is delayed. This authority is granted only after a reasonable effort has been made to contact me. This consent is valid while the child or ward is in the care or custody of Victory Defense Systems owner or their designated instructor or staff and this is for the sole purpose of authorizing medical treatment under emergency circumstances in my absence.
Victory Defense Systems, LLP, Adam and Karen Boyer, Tiger Kids Martial Arts, Future Tiger Kids Martial Arts, Akron Wing Chun, Keep S.A.F.E. Self Defense and Modern Mindfulness Method (collectively “Victory Defense Systems”) has put in place preventative measures to reduce the spread of COVID-19 or any other potentially infectious disease or agent during the specified pandemic declaration; however, Victory Defense Systems cannot guarantee that you and/or your child(ren) will not become infected with COVID- 19 or any other potentially infectious disease or agent. Further, attending classes provided by Victory Defense Systems could increase your risk and your child(ren)’s risk of contracting COVID- 19 or any other potentially infectious disease or agent.
By signing this agreement, I acknowledge the contagious nature of COVID-19 or any other potentially infectious disease or agent and voluntarily assume the risk that I and/or my child(ren) may be exposed to or infected by COVID-19 or any other potentially infectious disease or agent by attending a class with Victory Defense Systems and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 or any other potentially infectious disease or agent at a Victory Defense Systems class may result from the actions, omissions, or negligence of myself, my child(ren), and/or others including but not limited to Victory Defense Systems officers, agents, servants, independent contractors, affiliates, employees, volunteers, program participants and their families, and successors and assigns
I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself and/or my child(ren) including but not limited to personal injury, disability, and death, illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my and/or my child(ren)’s attendance at or participation in Victory Defense Systems’ programming (“Claims”). On my behalf, and on behalf of my children or any other family members, I hereby release, covenant not to sue, discharge, and hold harmless Victory Defense Systems and its officers, agents, servants, independent contractors, affiliates, employees, volunteers, program participants and their families, and successors and assigns, of and from the Claims, including all liabilities, claims, actions, damages, costs, or expenses of any kind arising out of or relating thereto. I understand and agree that this Waiver of Liability includes any Claims whether a COVID-19 or any other potentially infectious disease or agent infection occurs before, during, or after participation in any Victory Defense Systems program.
By signing below I, on behalf of myself, members of my family, my heirs, executors and administrators, acknowledge and represent that I have read this document, understand it, and sign it voluntarily as my own free act and deed, including without limitation the release of liability provisions contained in this document. I am sufficiently informed about the risks involved in using Victory Defense Systems to decide whether to sign this document. No oral representations, statements, or inducements, apart from the foregoing written agreement, have been made. I am at least eighteen (18) years of age and fully competent and I execute this document for full, adequate, and complete consideration fully intending to be bound by the same. I agree that this Wavier of Liability shall be governed by and construed in accordance with Ohio law and that if any of the provisions hereof are found to be unenforceable, the remainder shall be enforced as fully as possible and the unenforceable provision(s) shall be deemed modified to the limited extent required to permit enforcement of this Wavier of Liability as a whole.
I have carefully read and fully understand the contents of the forgoing Agreement and I have signed the forgoing Assumption of Risk Agreement of my own free will by signing entering my name in the webpage form.