JCI Taiko New Student Form
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GVJCI Liability Waiver and Photo Permission
WAIVER OF LIABILITY

As a participant in any program or class of the Gardena Valley Japanese Cultural Institute (hereafter known as “the JCI”), I recognize and acknowledge there are certain risks of physical injury, and I agree to assume the full risk of injuries, including death, damages or loss that I or my minor child may sustain as a result of participating in any activities connected with or associated with such program or class. I agree to waive and relinquish all claims I or my minor child may have as a result of participating in any program or class against “the JCI” and its officers, directors, agents, servants, employees and independent contractors. I further agree to indemnify and hold harmless and defend “the JCI” and its officers, directors, agents, servants, employees and independent contractors from my claims resulting from injuries, including death, damages and losses sustained by me or my minor child that arise out of, in connection with, or in any way associated with the
activities of this program.

I HAVE READ AND FULLY UNDERSTAND THE ABOVE WAIVER AND RELEASE OF ALL CLAIMS.

PHOTO PERMISSION

Please sign this waiver if you will permit use of your/your child’s image as described below. If you do not sign this waiver, we will not use your/your child’s image as described.
I understand that the Gardena Valley Japanese Cultural Institute (hereafter known as “the JCI”), is a non-profit organization that promotes all Japanese and Japanese American related culture not only to its students, but also to the Community at large. As such, articles, brochures, videos and websites may be used either promotionally or educationally and may include images of “the JCI” students or other participants in
our programs. I hereby permit the use of my/my child’s image to be photographed, videotaped or otherwise recorded for use in “the JCI” publicity or educational materials. These materials may include, but are not limited to, photographs of classes and performances, “the JCI” newsletters, various other publications, “the JCI” internet website and videos of classes or performances.

To see the pdf version: 
COVID Waiver
WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

FACILITY USER/PARTICIPANT AGREEMENT

In Consideration for being permitted to participate in the following activity or program
Taiko (The Activity), including any associated use of the premises, facilities, staff, equipment, transportation, and services of the Gardena Valley Japanese Cultural Institute, a California non-profit corporation (hereinafter also known as the GVJCI, facility and owner), I, the undersigned, for myself, heirs, personal representative, and assigns do hereby release, waive, discharge and promise not to sue the GVJCI, its directors, officers, employees, agents, programs sponsors, and sponsoring agencies from any liability for any and all claims, including negligence of the GVJCI, resulting in personal injury, (including death), accidents or illness and property loss, in connection with my use of the GVJCI facilities.
I, as a Facility User or Program Participant assume all risks and legal liability, waiving and releasing any and all claims for injuries, damages or loss Facility User/Participant may sustain as a result of any and all activities connected and associated with use of the Gardena Valley Japanese Cultural Institute (the “Facility” and “Owner”), located at 1964 W. 162nd Street, Gardena, CA 90247, against Owner, their officers, officials, agents,
and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises.
Facility User/Participant is fully liable for any and all loss or damage to the Facility, grounds, and/or equipment caused by Facility User/Participant or Facility User’s members or guests. The GVJCI is not liable for any latent or patent defects contained within the Facility, grounds, and/or equipment. Facility User/Participant understands that sports or physical activity, including, but not limited to, martial arts, physical fitness classes, etc., are athletic activities and Facility User/Participant assumes all risks associated with each respective activity.
The Facility User/Participant, and all of its members or guests, agrees to indemnify, hold harmless and defend Owner at all times from any liabilities, claims, actions, costs, losses, expenses or damages on account of personal injury, exposure to illness (e.g. MRSA, Influenza, COVID-19, etc.), death or damage to or loss of property or profits arising out of or resulting, in whole, or in part, from any act, omission, negligence, fault or violation of law or ordinance of Facility User/Participant or Facility User’s members or guests entering the Facility with the implied or express permission of Facility User/Participant to the fullest extent permitted by law.
The GVJCI is not responsible for any monetary loss to the Facility User/Participant due to any cancellations or facility closures done in accordance with government health orders. Facilities User/Participant acknowledges that they are subject to all applicable government health order. Noncompliance with health orders or GVJCI policies with result in termination of User/Participants permitted use or participation in Activity and
expulsion from the facility.
The GVJCI is not liable for any damage to or loss of personal property of the Facility User/Participant or Facility User’s members or guests using the facility and/or grounds. It is the responsibility of Facility User/Participant to ensure all minors are supervised by responsible adults provided or approved by the User. Facility User/Participant is responsible for the conduct of its members and guests and adherence to all applicable rules and policies of the GVJCI.
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Student Name *
Parent of Student (if minor) *
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Address *
Email Address *
Phone Number *
Emergency Contact Name *
Emergency Contact Phone Number *
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