Enrollment Form #1


 

 

CENTRAL PACIFIC AIKIDO ASSOCIATION

MILILANI AIKIDO CLUB

c/o 94-305 Kaaei Place                                                                                   Chief Instructor:  Mr. Dennis Oka                       

Mililani, Hawaii  96789

Telephone:   (808) 623-8937

 

 

STUDENT’S AGREEMENT TO:

WAIVE, RELEASE, INDEMNIFY, AND HOLD HARMLESS

 

 

     I, ___________________________________________________________, AGREE to comply with the rules and conditions set forth by the Central Pacific Aikido Association Mililani Aikido Club and its instructors.

 

     I KNOW that Aikido training involves physical exertion and is a potentially hazardous activity.

 

     I am aware of and ASSUME ALL RISKS associated with Aikido training, including, but not limited to, opening and closing of the training halls, warm-up and cool-down exercises, falls, kicks, and punches from sparring, weapons practice, high heat and humidity, and the conditions of the training areas.

 

     I FURTHER AGREE that I will not take any action in participating in Aikido training which will be dangerous to myself or any other person.

 

     In consideration of your accepting my application, I, for myself and anyone entitled to act on my behalf, WAIVE AND RELEASE from any and all claims for injuries and/or damages I may have against the Central Pacific Aikido Association Mililani Aikido Club, its instructors, agents, officers, and all members caused by the negligence of any of them arising out of participation in Aikido training.  I RELEASE, INDEMNIFY AND HOLD HARMLESS Central Pacific Aikido Association Mililani Aikido Club, its instructors, agents, officers, and all members from any and all claims arising out of or connected with any injury I may sustain in participating in Aikido training.

 

     I CERTIFY that I am physically fit and in sufficient physical and mental condition to participate safely in Aikido training.

 

     I FURTHER CERTIFY that I am covered by medical insurance and I will continue to maintain such coverage for as long as I am participating in Aikido training.

     THIS AGREEMENT shall be binding upon the undersigned’s family, estate, heirs, personal representatives, and assigns and shall inure to the benefit of the successors and assigns of the Central Pacific Aikido Association Mililani Aikido Club and its instructors, agents, officers, and all members.

 

     If I am under the age of eighteen (18), my parents or legal guardian, by signing below, hereby acknowledge and agree to all the terms and conditions set forth above.

 

     THE UNDERSIGNED, BY HIS OR HER SIGNATURE BELOW, ATTESTS THAT HE OR SHE IS FULLY INFORMED OF THE CONTENTS OF THIS AGREEMENT AND SIGNS THIS AGREEMENT AS HIS OR HER FREE ACT AND DEED.

 

     DATED:  Honolulu, Hawaii, ______________________________________    

 

 

                                                ______________________________________________________________

                                                Signature of Student

 

 

                                                ______________________________________________________________

                                                Signature of Parent or Guardian (if minor)