February 23, 2018
Release from Liability
SAN TAN AIKIDO KOKIKAI
LIABILITY RELEASE & EMERGENCY CONTACTS
I, the undersigned, have prepared myself mentally and physically for the San Tan Aikido Kokikai ("STAK") training. I am in adequate physical health and have no material injuries, mental or physical conditions or impairments whatsoever which would prohibit, impair, make difficult and advisably dangerous or physically harmful, my participation in the STAK training. If I have any such disabilities, I shall be responsible myself for making appropriate adjustments to accommodate such disability. I acknowledge that I must judge my own mental and physical capabilities with respect to STAK training program activities and have done so and will continue to do so. I have familiarized myself with the STAK curriculum and am aware of the nature of the rigorous physical activity which is a part thereof. I wish to participate in the STAK program. In consideration of acceptance into Aikido Kokikai classes, workshops, promotion exams and demonstrations, I, the undersigned, intending to be legally bound hereby for myself, my heirs, my executors, and my administrators, waive and release any and all rights and claims for damages I may ever have against San Tan Aikido Kokikai, L.L.C., Aikido Kokikai Federation, and their officers, instructors, agents, fellow students, and representatives for any and all injuries which I may suffer as a result of my participation in STAK functions. I understand and recognize that there is physical danger inherent in all martial arts, including STAK functions, and that I must exercise due caution in regard thereto. I do hereby specifically assume any and all risks of injury, accident, harm, death or damage of any nature whatsoever which may occur to me during or related to STAK functions. I further understand that I may excuse myself from any activity which I believe threatens to adversely affect my health. I, the undersigned, do further agree to indemnify and hold STAK, its officers, agents, instructors, students, assigns, successors in interest and anyone claiming right through STAK, harmless from any and all claims, demands, actions, liabilities, loss, expenses and/or costs or fees which may arise from or as a result of my participation in STAK functions. I do further hereby acknowledge that it is my own responsibility to provide full medical insurance coverage for any injuries I may sustain in STAK functions, and that I fully assume the risk of failing to procure such insurance. I also hereby give permission for my name and picture to be used in any broadcast, telecast, print media or advertising approved by STAK. In executing this document, I acknowledge that I have fully read and fully understood this form, and understand my own responsibilities and accept the restrictions described herein. I do further understand that STAK, if it chooses to extend its training and functions to me, does so in reliance upon this full release of liability and assumption of risk executed by me. I agree to be included in any filming, portrayals, brochures or advertising of the STAK without compensation or royalty, whether or not I am still a member at STAK at the time the picture or portrayal is disseminated, so long as the portrayals are not fraudulent or deceptive.