Informed Consent Liability Waiver
By choosing "agree" below this form I agree that I have been informed that I should not participate in any activity if I have any doubt or if I am uncertain as to my current medical condition. I understand that I should always seek medical advice before starting any physical training program.
I understand that the activities in which I participate are physically and mentally intense and may require extreme exertion and give rise to the possibility of injury or death. I hereby certify that I am in good health and do not suffer from any heart condition or other ailment that could be exacerbated by the exertion involved in the activities in which I participate. I confirm and agree that I am fully aware of the risk and certify that I (my child/legal ward) am physically able to participate in this program’s activities. I further agree that I will comply with all the rules, regulations, and instructions given to me by any program instructor, assistant instructor, or corporation official.
Further, I (on behalf of my heirs, personal representatives, executor, and administrator) hereby waive, release, remise, covenant not to sue and forever discharge from any claims and liabilities whatsoever without limitations that I have which arise against Mark Roemke, Robbin Finnerty, Santa Cruz Bujinkan, Pathways Dojo, Ninjas in Nature, The NEST and its owners/operators or any operator, official, supervisor, officer, participant, agent, instructor, agent, judge, volunteer, sanctioning entity, or employee from any expense, damage, loss, injury, or liability (including attorney fees) due to my decision to participate in any activity, class, seminar, or other event sponsored by Santa Cruz Bujinkan, The NEST, or Pathways Dojo. I agree to indemnify and hold harmless the above mentioned entities for any and all loss, injury, damage, claim, and liability. I confirm that I either have specific insurance to cover any injuries that I may sustain or that I have chosen to participate in these activities without any insurance coverage and agree to assume full responsibility of risk and bodily injury, death, and property damage. I hereby assume any and all risks, known and unknown, which may arise from my decision to participate in this activity. I agree to allow Santa Cruz Bujinkan, Pathways Dojo and affiliates to utilize any photograph, audiovisual recording, or other digital media taken of me or my child at any class or event. I understand that I will not be compensated in any way for use of any such digital media.
I hereby certify that I am at least 19 years of age. If the student is 18 or younger, the parent(s) and/or legal guardian (s) must select the "agree" button below.