Name *

First Name

Last Name

Date of birth *

MM

DD

YYYY

Parent or guardian

If registrant is under 18 years of age

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

How did you hear about the NY Aikikai?

Friends or family

Greater aikido community

Internet

Social media

I understand that dangers exist with respect to each Activity due to many factors, including without limitation my own or the Minor’s actions or inactions, the actions or inactions of others participating in such Activity, and the facility or other prevalent conditions. *

I agree

I fully understand that each Activity involves physical and other risks and dangers, including without limitation those of serious bodily injury, including permanent disability, paralysis and death (“Risks”) *

I agree

I hereby release, discharge, covenant not to sue and agree to hold harmless the releases of, from and against any and all claims, actions, demands, losses, costs, expenses, liabilities or damages resulting or arising from or incurred in connection with any activity (each, a “Claim”), including without limitation any Claim caused, resulting or arising from, or alleged to be caused, resulting or arising from, in whole or in part, the negligence of any owners, operators, lessors and service providers of or for the premises in or on which any Activity takes place (each, a “Releasee,” and collectively the “Releasees”). *

I agree

I further agree that if, despite this release, I, the undersigned parent or guardian, the minor or anyone on my, his, her or their behalf makes a Claim against any Releasee, I will indemnify, save and hold harmless such Releasee of, from and against any loss, cost, expense, damage, or liability that’s such Releasee may incur as a result of, arising from or in connection with such claim, including without limitation any attorneys’ fees, or other costs or expenses of litigation. *

I agree

I have read this agreement, fully understand its terms and understand that I have given up substantial rights by signing it. I have signed this agreement freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all claims and liability to the greatest extent allowed by law, and agree that if any term or condition herein is held to be invalid or unforce unenforceable for any reason, that all the terms and conditions here of shall continue in full force and effect. I certified by my signature that I have read and understand this agreement is entirety. *

I agree

I understand that New York Aikikai Ltd. may record and/or document activities and events involving classes and instruction. I agree or the minor and the undersigned parent or guardian each agree that New York Aikikai Ltd. may use any recording or other documentation, including, but not limited to, video tapes, photographs, or films, in which my or the Minor’s image or likeness appears for the promotion of Aikido and/or New York Aikikai Ltd. I understand and acknowledge that the New York Aikikai Ltd. shall be the sole owner of such recordings or other documentation. *

I agree