Application Form.doc 

MEMBERSHIP APPLICATION &

Release & Waiver of Liability & Indemnity Agreement (Read Carefully Before Signing)

SEIYO NO SHORIN-RYU KARATE KOBUDO KAI© (Seiyo Kai International ©)

& World Federation of Traditional Karate & Kobudo©

 

NAME________________________________________________________AGE_____

ADDRESS______________________________________________________________

CITY___________________________________________STATE____ZIP__________

COUNTRY______________________EMAIL_________________________________

MEMBERSHIP APPLICATION

In application for membership in Seiyo No Shorin-Ryu Karate Kobudo Kai, I agree to follow the guidelines of the Seiyo No Shorin-Ryu Karate Kobudo Kai, W. Dan Hausel, Soke, and Eric J. Hausel, Soke-Dai. I agree to support the spirit of traditional martial arts.

 

 I am applying for

___ Student Membership. Student membership is the basic membership. In addition to submitting this membership application, a fee of $35 is being forwarded as a check made out to Soke W. Dan Hausel, 1053 W. Cantebria Dr., Gilbert, Arizona 85233 USA

 

___Instructor Membership (See additional requirements in section A)

Warning, Waiver, and Release or Liability & Agreement to Participate.

In consideration of being permitted to participate in any way in the Martial Arts Program as instructed by W. Dan Hausel, Soke, of Seiyo No Shorin-Ryu Karate Kobudo Kai and his instructors, and/or being permitted to enter for any purpose any restricted area (here in defined as any area where in admittance to the general public is prohibited), I agree:

 

1. that prior to participating in any Seiyo Shorin-Ryu martial arts activity or event, I will inspect the facilities and equipment to be used, and if I believe anything is unsafe, that I (the participant) 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 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 participant or the action,

     inaction or negligence of others, including, but not limited to, the Releasees named below.

d. There may be other risks not known to us or are not reasonably foreseeable at this time.

 

3. I 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 negligence of the Releasees named below.

 

4. I HEREBY RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE the martial arts facility used by the participant, including its owners, managers, promoters, lessees of premises used to conduct the martial arts event or program, premises and event inspectors, underwriters, consultants and others who give recommendations, directions or instructions to engage in risk evaluation or loss control activities regarding the martial arts facility or events held at such facility and each of them, their directors, officers, agents, employees, all for the purpose herein referred to as “Releasee”…From all liability to the undersigned, my/our personal representatives, assigns, executors, heirs and next to kin 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 participant 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 negligence of the releasee or otherwise.

 

5. I 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. 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 Province or State in which the event is conducted and that if any portion is held invalid, it is agreed that the balance shall, notwithstanding continue in full legal force and effect.

 

7. If, despite the release, the participant makes a claim against any of the Releasees, the parents(s) and/or legal guardian(s) will reimburse the Releasee for any money which they have paid to the participant, or on his behalf , and hold them harmless.

 

I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WTHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.

 

Signed________________________________________________________________________________ Date_____________

 

Parent or Guardian Signature (if minor) _____________________________________________________________________

 

Printed Name of Participant______________________________ _________________________________________________

 

Address of Participant____________________________________________________________________________________

 

Received by________________________________________________   ____________________________________________

                                Registrar Signature                                                                                   Printed Name

INSTRUCTOR’S  APPLICATION

As an applicant for membership with Seiyo No Shorin-Ryu Karate Kobudo Kai as an instructor, I am providing the following information concerning my background. 

 

Full Name:______________________________________________________________________________________________

Style:___________________________________________________________________________________________________

Rank:___________________________________________________________________________________________________

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