This is a legal document that affects my rights, my child’s rights or the rights of an individual for whom I have authorised decision-making responsibility, as the case may be (Student). I acknowledge that the activities the Student will engage in may involve a significant degree of physical exertion and a degree of physical risk and that the activities may involve testing the Student’s physical and mental limits and carries with it the potential for injury.  THE STUDENT WILLINGLY ASSUMES ALL OF THE RISKS OF PARTICIPATING IN ANY AND ALL EXERCISES AND ACTIVES OF HEISHIN-KAI KARATE.

I certify that the Student is physically fit and has sufficiently prepared or trained for participation and there are no reasons (health or otherwise_ which preclude the Student’s participation. I certify that i have provided Heishin-Kai with all relevant and necessary information that relates to the Student’s physical health and capacity to participate in strenuous exercise. I understand that without all of the relevant and necessary information Heishin-Kai would not be able to fully appreciate the risk of harm or injury to the Student in providing instruction and in allowing the Student to participate in this activity. I (or my parent or guardian) willing provide the following waiver.

(a) I do not hold Heishin-Kai or its employees, agents or volunteers legally responsible for injuries the Student suffers on its premises or using any equipment in its training or activites (conducted on the premises or elsewhere).

(b) I undertake not to sue Heishin-Kai or its employees, agents or volunteers for any claims, costs, damages, or other liabilities they may have for injury and any consequential losses (including economic loss) suffered by the Student and I acknowledge that this waiver represents a legal release and discharge of legal responsibility to Heishin-Kai or its employees, agents or volunteers. It is provided in exchange for the instruction and activities, and other services purchased by me or on behalf of the Student.

(c) I accept that the Student will also be assuming a role involving responsibility for the safety of others participating in the activities of Heishin-Kai. This means the Student will accept resonsibility for the safety of others and if an injury occurs as a result of the Student’s careless act, omission or negligence then I fully assume responsibility for any harm done and I do not hold Heishin-Kai concurrently responsible.

I give consent to Heishin-Kai to make, use and/or retain an image or recording that may identify the Student (including use of the Student’s name) and I waive all rights to any claims for payment or royalties in connection with the use of the Student’s image. I understand that by giving consent, Heishin-Kai can use the image or recording to promote Heishin-Kai activities and reproduce the image or recording in any form and distribute the works by any medium including the Internet.