South Mountain Martial Arts
91 Main Street, Madison New Jersey 07940-1849
Jujitsu: (973) 822-1977 | Fencing: (973) 906-3503
Ninjutsu Seminar
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WARNING, WAIVER AND RELEASE OF LIABILITY AND AGREEMENT TO PARTICIPATE
A COMPLETED COPY OF THIS FORM MUST ACCOMPANY THE PRE-REGISTRATION FORM
In consideration of being permitted to participate in any way, including travel to and from, in any activity, demonstration, practice, clinic, sparring and related events and activities of the Kawakami Ninjutsu Seminar, I hereby:
1. Acknowledge that I am familiar with the activities pertaining to martial arts, including but not limited to Ninjutsu and understand the rules governing these activities.
2. Agree that prior to participating, I will inspect the
mats, equipment, facilities, planned event schedule, the nature of all activities in
which I may be asked to participate
, and if I believe anything is unsafe
or beyond my capability
, I will
immediately advise my host
,
instructor, coach or supervisor of such condition(s) and refuse to participate.
3. Acknowledge and fully understand that I will be engaging in a contact activity that might result in serious injury, including permanent disability or death, and severe social and economic losses due to notonly my own actions, inactions or negligence, but also to the action, inaction or negligence of others, the rules pertaining to any martial arts participation, the nature of Ninjutsu as practiced at the event, or conditions of the premises or of any equipment used. Further, I acknowledge that there may be other risks not known to me or not reasonably foreseeable at this time.
4. Knowing the risks involved in the participation of martial arts activities, particularly but not limited to Ninjutsu , I assume that risk and accept personal responsibility for the damages following such injury, permanent disability or death.
5. Release, waive and discharge and covenant not to sue Drew University, Jinichi Kawakami, Yasushi Kiyomoto, Dayn DeRose, South Mountain Martial Arts, their affiliated clubs, their respective administrators, directors, agents, coaches, instructors and other employees or volunteers of these organizations, event officials,
medical personnel
, other participants, their parents, guardian(s), supervisors and coaches, sponsoring agencies, sponsors, advertisers, and, if applicable, owners, lessors, and lessees of premises used to conduct the event, all of whom are hereinafter referred to as “releasees
”
, from any and all claims, demands, losses, or damages on account of injury including permanent disability and death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the releasees or other wise.
6.
Parent(s) or legal guardian(s) of minor participants (age 18 and below) additionally agree that they will instruct the minor
participant to the above warnings and conditions and their ramifications, and that they consent to the minor's
participation.
I HAVE READ THE ABOVE
WARNING
, WAIVER AND RELEASE, UNDERSTANDING THAT I GIVE UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND KNOWING THIS, SIGN IT VOLUNTARILY.
I AGREE TO PARTICIPATE KNOWING THE RISKS AND CONDITIONS INVOLVED AND DO SO ENTIRELY ON MY OWN FREE WILL.
___________________________________ ___________________________________ _______________
(Participant) (Signature) (Date)
___________________________________ ___________________________________ _______________
(Parent or legal guardian of participant) (Signature) (Date)
