Request edit access
Agreement and Waiver of Liability
By submitting this form, you are releasing legal claims. Please read carefully.
Randa KyoFit Karate Academy
Sign in to Google to save your progress. Learn more
Email *
1- Randa KyoFit Karate Academy, or any party designated by Randa KyoFit Karate Academy, may photograph or film me while I attend the premises of Randa KyoFit Karate Academy, and use any and all such photos, video footage and/or video streaming for promotion, sales, publicity and advertising purposes for all media, including, but not limited to the internet. *
2- Karate and/or Martial arts programs require physical exertion which maybe strenuous and cause physical injury, and I’m fully aware of the risks and hazards involved. I hereby declare that I’m mentally and physically fit to receive and participate in the prescribed course of instruction. I acknowledge that I have been advised to consult with a physician prior to and regarding my participation in the classes and that my physician has confirmed to me that I have no medical condition which would affect my full participation in the classes. *
3- In consideration of my being permitted to participate in the classes, I for myself, my heirs, executors, administrators, successors, assigns and anyone else who may claim on my behalf hereby waive any and all claims, liabilities and damages I may now or in the future have against Randa KyoFit Karate Academy, its directors, officers, instructors, staff, partners and all persons acting under its authority and their respective heirs, executors, administrators, successors, and assigns, arising by any means whatsoever, including, but not limited to death, injury, damages to or loss to my person or property of any kind whatsoever , no matter how caused arising from or in connection with my participation in the classes, however caused and/or arising from or in connection with my participation in National/International Internships and Camps and/or National/International Competitions, however caused. *
4- I further hereby release, remise and forever discharge Randa KyoFit Karate Academy, all  locations used by Randa KyoFit Karate Academy , its owners, its directors, officers, partners, instructors and staff and all persons acting under its authority and their respective heirs, executors, administrators, successors and assigns from and against all demands, claims, actions, damages, costs and expenses arising from or with respect to death, injury, damages to or loss to my person or property of any kind whatsoever, no matter how caused, arising from or in connection with participation in the classes whether or not caused by, in whole or in part, negligence or gross negligence, breach of contract, breach of any statutory or other duty of care, including any duty owed under the Occupiers ‘liability Act (Ontario). *
5- I will hold harmless and identify Randa KyoFit Karate Academy, its directors, officers, partners, instructors and staff and all persons acting under its authority and their respective heirs, executors, administrators, successors and assigns from any and all liability for any damage or injury to the property or persons of any third party resulting from the Releasor’s involvement in or presence during any of the Classes and/or National/International Internships and Camps and/or National/International Competitions. *
6- I will comply with all the rules and regulations of Randa KyoFit Karate Academy (RKKA) *
7- I acknowledge that everyone who participates in Randa KyoFit Karate Academy classes must be a member of the Academy. Membership registration fee: $50. No refund or cancellation is given for Membership fee, Monthly fees, or 3 month fees. Payment must be paid in full prior to the First class. *
8- I will be solely responsible for the transportation of my child to any competition and/or internship/camps through my own transportation means. *
9- I acknowledge that wearing earrings, watches, necklaces, bracelets, rings, barrettes and other jewelry are prohibited in the classes to avoid accidents and that students must be present 10 minutes before the start of the class wearing a neat, clean Karate uniform. *
10- I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the Ottawa Public Health and many other public health authorities still recommend practicing social distancing. *
11- I further acknowledge that RKKA has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19. *
12- I further acknowledge that RKKA cannot guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, RKKA staff, and other RKKA clients and their families. *
13- I voluntarily seek services provided by RKKA and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending my class and I will wear mask upon entering the facility. I acknowledge that if I’m feeling unwell or/and have any symptoms of COVID 19, I will cancel my class and will not show up for 14 days.I attest that:* I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.* I have not traveled internationally within the last 14 days.* I have not traveled to a highly impacted area within the United States of America or any other country in the last 14 days.* I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.* I have not been diagnosed with Coronavirus/Covid-19 or been in contact with anyone who has* I am following all Ottawa Public Health recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19. *
14- I confirm that the provisions in this Agreement constitute the entire agreement between the parties hereto and supersede all prior communications, proposals, representations and agreements, whether oral or written with respect to the subject matter of this agreement. *
15- I acknowledge having been given full opportunity to read this agreement before signing it, having full opportunity to ask questions regarding the activity, and having read and understood this agreement (or where the participant is a minor, having parent or legal guardian read the agreement and explained it to the participants) and received a copy of this agreement. *
16- I understand my rights and obligations as stated above. I confirm that I am a Parent/Legal Guardian of the minor stated below and that I have read and understood this release and waiver of liability and I am aware that by signing this Agreement I am waiving certain legal rights, including the right to claim damages which I or my heirs, executors, administrators, successors or assigns may have against Randa KyoFit Karate Academy. *
In witness whereof, I have executed this release with written digital signature and agree to the terms above, as of... *
MM
/
DD
/
YYYY
Name of Minor *
Date of Birth of Minor *
MM
/
DD
/
YYYY
Printed Name of Parent/Legal Guardian  – Please type your full legal name. Initials will not be accepted as a valid electronic signature. *
Email of Parent /Legal Guardian *
Phone Number of Parent /Legal Guardian *
By clicking the submit button below, I hereby agree to and accept the above terms. *
Required
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Randa KyoFit Karate Academy.

Does this form look suspicious? Report

Google Forms