Masjid Noor Martial Arts Class Registration
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Student's Name *
Age *
Date of Birth *
School Grade *
Phone Number *
Email address *
Parent/Guardian Name *
Full Home Address *
Emergency Contact Name(Other than Parent) *
Emergency Contact Phone Number *
Release & Waiver of Liability *
READ CAREFULLY BEFORE SIGNING. MARTIAL ARTS / CONTACT SPORT ACTIVITIES CAN BE DANGEROUS AND CAN INVOLVE SUBSTANTIAL RISK OF SERIOUS BODILY INJURY AND/OR HARM! In consideration of being permitted to participate in any way in the Martial Arts classes at Masjid Noor, Inc., the parent(s) and/or legal guardian(s) of the minor participant named below (the “Minor”) agree that: 1. The parent(s) and/or legal guardian(s) of the Minor will themselves, inspect the facilities and equipment to be used, prior to the Minor participating in the Classes, and if he or she believes anything is unsafe, the Minor or the parent(s) and/or legal guardian(s) of the Minor should immediately advise the officials of such condition and refuse to participate. I understand and agree that, if at any time, I feel anything to be UNSAFE; I will immediately take all precautions to avoid the unsafe area and REFUSE TO PARTICIPATE further. 2. I/We fully understand and acknowledge that: a. There are risks and dangers associated with participation in martial arts events and activities, which could result in bodily injury partial and/or total disability, paralysis and death. b. The social and economic losses and/or damages, which could result from these risks and dangers described above, could be severe. c. These risks and dangers may be caused by the action, inaction or negligence of the Minor or the action, inaction or ordinary negligence of others, including, but not limited to Masjid Noor, Inc., their officers, agents and/or employees, other participants, owners and lessor of premises used for the activity, and the other “Releasees” named below. d. There may be other risks not known to us or that are not reasonably foreseeable at this time. 3. I/WE accept and assume such risks and responsibility for the losses and/or damages following such injury, disability, paralysis or death, however caused and whether caused in whole or in part by the ordinary or gross negligence of Masjid Noor, Inc. or the other Releases named below. 4. I/WE, and my/our personal representatives, assigns, executors, heirs and next to kin, HEREBY RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE, Masjid Noor, Inc. including its board of trustees, officers, instructors, sub contractors, directors, employees, managers, (all of the above parties are for the purpose of this document also referred to as “Releasees” from all liability to the undersigned) for any and all claims, demands, losses or damages and any claims or demands therefore on account of any injury, including but not limited to the death of the Minor or damage to property, arising out of or relating to the events(s) caused alleged to be caused in whole or in part by the ordinary or gross negligence of the Releasee or otherwise. 5. I/WE HEREBY acknowledge that THE ACTIVITIES OF THE EVENT(S) ARE VERY DANGEROUS and involve the risk of serious injury and/or death and/or property damage. Each of THE UNDERSIGNED also expressly acknowledges that INJURIES RECEIVED MAY BE COMPOUNDED OR INCREASED BY NEGLIGENT RESCUE OPERATIONS OR PROCEDURES OF THE RELEASEES. 6. EACH OF THE UNDERSIGNED further expressly agrees that the foregoing release, waiver, and indemnity agreement is intended to be as broad and inclusive as is permitted by the law of the State of New York and that if any portion is held invalid, it is agreed that the balance shall, notwithstanding continue in full legal force and effect. 7. I/WE hereby certify that I, the Minor is in good health and has no mental or physical condition or symptoms that could interfere with my/our/his or her safety or the safety of others while participating in any activity, using any equipment or facilities of Masjid Noor, Inc. I/WE understand and agree that I/WE alone am/are responsible to determine whether I, and/or, the Minor am physically and mentally fit to participate, perform or utilize the activities, programs, equipment or facilities made available by Masjid Noor, Inc. and that I/WE am NOT relying on any advice from Masjid Noor, Inc. in this regard. To the extent I/WE have any questions or need any information about the Minor’s physical or mental condition or limitations, I/WE agree to seek professional advice from a qualified physician. In the event I cannot be reached in an emergency, I hereby give my consent to Masjid Noor, Inc., its instructors, employees, or any Emergency Medical Personnel to administer or secure any necessary treatment to the Minor in the event of an emergency and transport him/her by ambulance if the situation warrants.8. I/WE affirm that I/WE freely and voluntarily signed this agreement without inducement, assurance or guarantee being made or that I/WE are the parent(s) or legal guardian(s) of the Minor for whom I/WE are giving up legal rights and/or remedies which may be available to the Minor for the ordinary or gross negligence of Masjid Noor, Inc. or the other Releasees. 9. By signing this form I/WE agree to comply, or, to ensure as far as possible that the Minor will comply with all Masjid Noor Inc.’s rules and regulations. 10. I/WE acknowledge the information I/WE has/have provided is true and correct I/WE HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, FULLY UNDERSTAND ITS TERMS AND INTEND MY/OUR SIGNATURE(S) TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.
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