Directions: Print this form, complete it, sign it, and return it to class.

Welcome to Florida Aikikai

Florida Aikikai New Member Registration Form
(Please print clearly)

Name:___________________________________________________________Birth Date: _____/_____/_______

Address:____________________________________________________________________________________

City:_____________________________________________________State:______ Zip:____________-________

Phone(________)___________________Email _____________________________________________________

Occupation: __________________________________Hobbies/Talents: __________________________________

Other Martial Art Experience:____________________________________________________________________

Injuries:_____________________________________________________________________________________

 

Hold Harmless Agreement

This school, its agents, servants or employees, shall not be responsible or in any way liable to the student, his or her parents, guardians, heirs, executors, administrators, or assigns, for any damages, or redress in any form for any injuries caused to or sustained by the student because of an accident of any kind, whether such an accident shall be caused by or arise from its negligence or from any cause whatever except that this waver of liability shall not extend to any such agent, servant or employee who causes any such injury by his willful act.

The student or the student's parents or guardians assume the risk of injury to the student while attending courses or lessons or any activity.

The undersigned student or the undersigned parent or guardian of the student, for himself, his heirs, executors and administrators covenants not to sue the school, its agents, servants and employees and shall indemnify and save harmless the school, its agents, servants and employees, against all damage, loss or expense which they or any of them incur as the result of any claim or action which may, at any time, be made or instituted by or on behalf of the undersigned student or his representatives including, without being limited to any claim or action based upon negligence of the School, its agents, servants or employees.

IN WITNESS WHEREOF the parties hereto have hereunto set their hands and seals, this________day of ________, 20__.

___________________________________
Student

___________________________________
Parents or Guardian (Required if student is under 18)

___________________________________
Florida Aikikai Representative

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