2024 Waiver | Isshinryu

HELP

USIKA Waiver of Liability

The Parties includes: United States Isshinryu Karate Association (USIKA), USIKA Board of Directors, USIKA Members, usikaevents.com, Phil Little, Phil Little Karate School(s) (PLKS) and Guest Instructors, Host Facility, YMCA- Anderson, USIKAEvents, et al., are hereinafter referred to as Host.

Adult Participant

Parent / Guardian

Date of Birth

Are your Children generally healthy and able to participate in intense excersise.

Yes

Initials

In the event you are signing on behalf of a minor child, you assume any and all responsibility. You are affirmatively stating that you have legal authorization to sign the waiver on behalf of the minor child and indemnify and hold harmless the Host and you have authorization to sign the waiver. In the event you actually do not have legal authorization you indemnify and hold harmless the Host for any and all liability. We are relying on your representation of authority and by signing this you represent you have actual authority.

CHILDREN NAMES & DOB

List Limitations if Any For Any Listed Participant

Any Issue or Informaion you believe we should know?

ACKNOWLEDGMENT OF REQUIRED SAFETY STANDARDS All Personal Protective Equipment (PPE) is the competitor's sole responsibility. Required Minimum PPE, includes the Industry Standard Equipment: 1. Head Protection, 2. Mouth Guard, 3. Groin Protection (worn under uniform), 4. Hands and Foot Pads. Recommended Additional PPE includes other Industry Standard Equipment, but is not limited to: Chest Protection, Face Shield, Shin Protection (worn under uniform), Forearm Protection (worn under uniform). I have been advised of the required minimum PPE for participation and assume all risk associated with the use of PPE.

ADDITIONAL WAIVER OF CLAIMS: Host reserves the right to alter any division if there are insufficient entrants. Categories of all competitions may be altered. Competitors who are not prepared to compete when called are subject to disqualifications.

USE OF MEDIA: I hereby waive any compensation whatsoever for the use of pictures, movies, media coverage etc utilized by Host at any time.

ASSUMPTION OF RISK: I do hereby acknowledge and understand that Karate is a contact sport wherein physical injury is an inherent risk. I hereby assume any and all risks and injuries of any type whatsoever including, but not limited to death and / or paralysis, associated with participation in this sport. I do hereby release, remise and discharge Host in the above stated activity due to negligence or any other fault, including intentional acts. Participant agrees to indemnify and hold harmless any and all other parties from any and all legal claims arising from any illness or injury related to participation in activities. Moreover participants agree to provide appropriate insurance to effectuate said indemnification or failure to provide adequate insurance results in a waiver of all claims. For example, if a leg is broken, health insurance must cover that injury in full and that provider cannot seek a subrogation claim or reimbursement from the Host. Your medical insurance cannot sue us to cover the bill.

The Undersigned hereby release and remise Host, as defined above., all persons associated with this event in any capacity, including but not limited to other competitors and / or participants from any and all liability due to illness or injury etd., including death and / or paralysis that I may incur as a result of my attendance and / or participation.

Dojo / School / Instructor

Adult Participant and/or Parent / Guardian Signature

Select a date

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