ACKNOWLEDGEMENT OF RISK, WAIVER, RELEASE & INDEMNITY Adults, 19+ years

Dojo: Vancouver Seiyu Karate dojos

All references herein to the “Dojo” include the Vancouver Seiyu Karate dojos (Vancouver Downtown, Richmond, and Killarney locations) and the Central Presbyterian Church (the management of the Vancouver Downtown dojo's building), any society or association involved in the operation of and/or provision of programs or services at the Dojo and all of their respective officials, directors, instructors, employees, volunteers, and agents.

Activity Description:
Karate classes provided by Vancouver Seiyu Karate
Activities included:
Beginner to Intermediate Class
Intermediate to Advanced Class

AWARENESS OF RISKS
I AM AWARE THAT THERE ARE RISKS OF HARM IN MY PARTICIPATION IN THE ACTIVITY, INCLUDING,
WITHOUT LIMITATION, RISKS OF PHYSICAL HARM AND:
1) I am aware and acknowledge that the activity by its nature is such that the Dojo cannot identify all possible risks associated with it; and
2) cannot guarantee or provide any assurance that Dojo personnel involved in the activity will not make errors that might create risks of harm to me therein; or
3) cannot guarantee that Dojo personnel will be able to protect me from risks associated with the activity, including, without limitation, risks created by others participating in the activity; and
4) the nature of the Activity is such that I will interact with other people, continuous physical distance between myself and other people cannot be guaranteed, and, by participating in the Activity, I risk being infected by a pathogen, including but not limited to SARS-COV-2. SARS-COV-2, which causes the disease COVID-19, may exacerbate other health issues and is the cause of an ongoing global pandemic. SARS-COV-2 is highly communicable and dangerous. If I become infected with SARS-COV2, I may transmit it to other people even if he, she, or they is not exhibiting symptoms of illness; and

I NOW FREELY ACCEPT AND ASSUME FULL RESPONSIBILITY FOR ALL RISKS TO ME IN CONNECTION WITH MY PARTICIPATION IN THE ACTIVITY. IN RETURN FOR THE DOJO ALLOWING ME TO PARTICIPATE

IN THE ACTIVITY:
1) I NOW WAIVE ALL LEGAL RIGHTS TO SUE AND ANY AND ALL CLAIMS I and my successors and assigns may have against the Dojo in connection with any loss, injury, damage or expense of any kind that I may in any way suffer, incur or experience as a result of or in connection with my participation in the Activity; and
2) I HEREBY RELEASE the Dojo from any and all liability for any complaints, demands, claims, actions, suits, judgements and orders for any and all losses, injuries, damage, or expenses I may suffer, incur or experience in connection with my participation in the Activity; and
3) I AGREE TO INDEMNIFY the Dojo for and hold it harmless from any and all losses, injuries, damages and expenses of any kind that the Dojo may suffer, incur or experience and for any and all complaints, demands, claims, actions, suits, judgements and orders for any and all losses, injuries, damages or expenses of any kind anyone else may suffer, incur or experience in connection with my participation in the Activity.

Registration Information

Name (First/Last) *

Gender

Date of Birth (Month/Day/Year) *

Address *

Email *

Cell Phone *

Emergency Contact Person Name *

Relation to Participant *

Emergency Contact Cell Phone Number *

Health Questions

Are you covered by BC Medical or any other medical insurance? *

Yes

No

Do you have a history of heart-related illness? *

Yes

No

Do you carry any virus such as HIV or Covid-19 which might infect other people? *

Yes

No

(For a female student ) Are you pregnant? *

Yes

No

Have you ever been declined to participate in any sports activities because of your health problems? *

Yes

No

List any medical or behavioural concerns staff should be aware of. Please include allergies, life threatening conditions, disabilities, or extra assistance required. This information helps staff determine if they can reasonably accommodate you.

GENERAL WAIVER AND FORM AND PHOTO & VIDEO RELEASE

AI hereby authorize the Dojo to photograph and/or otherwise record images and/or sounds of me participating in the Activity described above and to freely publish and otherwise make use of as it wishes, without compensenation of any kind to me or anyone else, of all such recordings for purposes of documenting and/or promoting Dojo programs and services. Examples include: use in program brochures, photo displays, and Dojo social media such as web posting and video.

In signing this document, I do not rely upon any oral or written statements, promises or other communications made by the Dojo other than as set out in this document. This document will be exclusively governed by and interpreted in accordance with the laws of British Columbia and no court outside British Columbia will have any jurisdiction over this Consent, the Activity, or any of the matters arising from them.

I HAVE READ AND I ACCEPT THIS DOCUMENT.

NAME *

SIGNATURE *

clear