ACKNOWLEDGEMENT AND RELEASE FORM
1. Assumption of Risk
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' courses 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, sparring with 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 acknowledge that Martial Arts Instruction is a hazardous activity and voluntarily participate in this activity with knowledge of the dangers involved. I hereby agree to accept any and all risks of injury or damage arising from my participation.
I acknowledge that Martial Arts Instruction is a hazardous activity and voluntarily participate in this activity with knowledge of the dangers involved. I hereby agree to accept any and all risks of injury or damage arising from my participation.
2. Waiver and Release
The undersigned hereby releases and discharges Victory Defense Systems, including its owners, instructors, assistant instructors, other participants, or students, and all Designated Facilities, from all claims, demands, damages, rights of action, or causes of action, present or future, whether known or unknown, anticipated or unanticipated, resulting from or arising out of the undersigned’s use (or intended use) of Martial Arts Instruction, Designated Facilities, equipment, and weapons. This waiver applies to any incident resulting from engaging in Martial Arts Instruction or otherwise following Martial Arts Instruction anywhere.
3. Indemnification
The undersigned agrees to indemnify, defend, and hold harmless Victory Defense Systems, its owners, instructors, agents, and employees from any and all claims, actions, suits, procedures, costs, expenses, damages, and liabilities, including attorney’s fees, brought as a result of the undersigned’s involvement in Martial Arts Instruction and to reimburse them for any such expenses incurred.
4. Health and Medical Authorization
I currently have no known physical or mental condition that would impair my capability for full participation in Martial Arts Instruction. If the participant 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 behalf of my child or ward to the terms of this 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 is for the sole purpose of authorizing medical treatment under emergency circumstances in my absence.
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 behalf of my child or ward to the terms of this 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 is for the sole purpose of authorizing medical treatment under emergency circumstances in my absence.
5. Infectious Disease Disclaimer
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”) have put in place preventative measures to reduce the spread any potentially infectious disease or agent. However, Victory Defense Systems cannot guarantee that you and/or your child(ren) will not become infected with any 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 any potentially infectious disease or agent.
By signing this agreement, I acknowledge the contagious nature of potentially infectious disease or agent and voluntarily assume the risk that I and/or my child(ren) may be exposed to or infected by any potentially infectious disease or agent by attending a class with Victory Defense Systems. 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 any 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, 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, 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 any potentially infectious disease or agent infection occurs before, during, or after participation in any Victory Defense Systems program.
By signing this agreement, I acknowledge the contagious nature of potentially infectious disease or agent and voluntarily assume the risk that I and/or my child(ren) may be exposed to or infected by any potentially infectious disease or agent by attending a class with Victory Defense Systems. 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 any 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, 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, 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 any potentially infectious disease or agent infection occurs before, during, or after participation in any Victory Defense Systems program.
6. Miscellaneous
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, fully competent, and I execute this document for full, adequate, and complete consideration fully intending to be bound by the same.
7. Severability
If any provision of this agreement is found to be unenforceable or invalid, that provision shall be limited or eliminated to the minimum extent necessary so that this agreement shall otherwise remain in full force and effect and enforceable.
8. Governing Law
I agree that this Waiver of Liability shall be governed by and construed in accordance with Ohio law.
9. Acknowledgment of Understanding
I acknowledge that I have read this waiver of liability and fully understand its terms. I understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing the agreement freely and voluntarily and intend my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.
