WARNING! LIABILITY WAIVER & RELEASE FORM
Completion Required for All Students and Participants
I acknowledge and fully understand that I will be engaging in a contact sport and/or physical activity that might result in serious illness and/or injury, including permanent disability or death, and severe social economic losses due to not only my own actions, inactions or negligence, but also to the action, inaction or negligence of others, 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. In consideration for instruction, and understanding that participation in Judo, JuJutsu or other programs may result in harm to me, I, on my own behalf, and on behalf of the heirs, executors, and administrators of my estate, release and forever discharge any and all rights and claims I may have or which may hereafter accrue to me or my estate against Southwestern Pennsylvania Judo, LLC, its owners, officers, instructors, members and affiliations for any and all damages which I may sustain or suffer in connection with my participation at Southwestern Pennsylvania Judo & JuJutsu, including injuries sustained or suffered while traveling to and from any event in connection with Southwestern Pennsylvania Judo, LLC.
I HAVE READ THE ABOVE WARNING, WAIVER AND RELEASE, AND UNDERSTAND THAT I GIVE UP SUBSTANIAL LEGAL RIGHTS BY SIGNING IT, AND KNOWING THIS, SIGN IT VOLUNTARILY. I AGREE TO PARTICIPATE KNOWING THE RISKS AND CONDITIONS INVOLVED AND DO SO ENTIRELY OF MY OWN FREE WILL. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENT/GUARDIAN AS EVIDENCED BY THEIR SIGNATURE BELOW.
FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE
(UNDER 18 AT TIME OF REGISTRATION)
THIS IS TO CERTIFY THAT I, AS PARENT/GUARDIAN WITH LEGAL RESPONSIBILITY FOR THIS PARTICIPANT, DO CONSENT AND AGREE TO HIS/HER RELEASE, AS PROVIDED ABOVE, OF ALL THE RELEASEES, AND, FOR MYSELF, MY HEIRS, ASSIGNS, AND NEXT OF KIN, I RELEASE AND AGREE TO INDEMNIFY AND HOLD HARMLESS THE RELEASEES FROM ANY AND ALL LIABILITIES INCIDENT TO MY MINOR CHILD’S INVOLVEMENT OR PARTICIPATION IN THIS PROGRAM AS PROVIDED ABOVE, EVEN IF ARISING FROM THEIR NEGLIGENCE, TO THE FULLEST EXTENT PERMITTED BY LAW. I HAVE INSTRUCTED THE MINOR PARTICIPANT AS TO THE ABOVE WARNING AND CONDITIONS AND THEIR RAMIFICATIONS.
