Waiver-Release/Financial Agreement
In consideration to being allowed to participate in any-way in the sports programs, related events and activities of MSJ The Undersigned:
1) Agree that prior to participating, he/she will inspect the facilities and equipment to be used and if he/she believes them to be unsafe, to immediately advise his/her instructor of such conditions(s) and refuse to participate. Parent (s) or legal guardian(s) of minor participants agree that they will instruct the minor to this effect.
2) Acknowledge and fully understand that each participant will be engaging in activities that involve risk of serious injury, including permanent disability and death, and severe social and economic losses which might result not only from their own actions, inactions or negligence, but the action, inaction or negligence of others, the rules of play, or conditions of the premises or of any equipment used.Further, that there may be other risks not known to them or not reasonable at this time.**
3) Assume all the foregoing risk and accept personal responsibility for the damages following such injury, permanent disability or death.
4) Understand and release that some activities will/may include driving or transporting participants in private vehicles to and/or from activities. That all parent(s), Guardian(s) and participants understand and agree.
5) Release, waive, discharge and covenant not to sue Mountain Storm Jujitsu, Martial Arts Studio, its affiliated schools, clubs, their respective administrators, directors, agents, Coaches and other employees of the organization, or their participants, their parents(s) Guardian(s), supervisors and coaches, sponsoring agencies, sponsors, advertisers and if applicable, owners and lessors of premises used to
conduct the event, all of which are hereinafter referred to as the *releasers*, from any and all liability to each of the undersigned, his or her heirs, and next of kin for any and all claims, demands, losses or damages on account of injury, including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the releasers or otherwise.*
6)Financial Policies and Refunds: All payments shall be made in advance of event. If for a reason deemed as *uncontrollable* by leasers occurs and participant has attended a portion of event, refund will be based on a per day rate and will be given at that rate. Refund will not be given if only one day of event remains on participants contract.*
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Printed Name of Participant Signiture Date
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Printed Name of Parent/Gaurdian Signiture Date
*Clinics & Registration Gift Only $89.
*Clinics, Lodging, 5 meals and registration gift are all included Only $159.00.
Name:____________________________________Birthdate:__________ Phone:__________________________
Emergency Contact#_______________ Mailing Address:_________________________
City:__________________________ State:_______ Zip:_______________
In case of emergency notify: (Name, Phone No., Relation)
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Medical Information:
Physician Name: _____________________ Phone No._______________
Medications: _________________________________________________
Allergies: _____________________ Immunizations Current (Y/N)
Injuries or other conditions that may affect participation:__________________________
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Space is limited, so register Today.
Add $10.00 After Jan. 2, 2005
Mail to: 19405 Village Dr/ Sonora/ CA / 95370
AJJF Membrship is required.
Membership forms and Partial memberships will be availible