Youth Information & Goal Assessment

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Student Name
Student Birth Date
Parent/Legal Guardian Name
2nd Parent/Legal Guardian Name
What goals would you like your child to achieve as a student at AHMA?
Release & Waiver of Liability
By agreeing to these terms, I declare myself the parent or legal guardian of the aforementioned student or participant, hereby known as the releasor and certify that I am at least 18 years of age.

1. I hereby acknowledge and fully understand that:
a) I should inspect the facilities and equipment to be used and if I believe anything is unsafe, immediately advise the officials of such conditions and refuse to participate in the event(s).
b) There are risks and dangers associated with participation in martial arts and events which could result in bodily injury, partial and/or total disability, paralysis and death.
c) The social and economic losses and/or damages, which could result from these risks and dangers described above, could be severe.
d) These risks and dangers may be causes by the action, inaction or negligence of the participant or the action, inaction or negligence of others, including, but not limited to the Releasee.
e) I am aware of the existence of the risk of participation that may cause injury or illness such as, but not limited to Influenza, MRSA, or COVID-19 that may lead to paralysis or death.
f) There may be other risks not known to me or are not reasonably foreseeable at this time.

2. I accept and assume all 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 Releasee.

3. I hereby release, waive, discharge and covenant not to sue Art Hinkelbein Martial Arts Academy LLC, the martial arts facility used by the student/participant, including its owners, managers, promoters, lessees or premised used to conduct the martial arts event or program, premises and event inspectors, underwriters, volunteers, 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 purposes herein referred to as “Releasee” from all liability to the Releasor, my personal representatives, assigns, executors, heirs and next to kin for any and all claims or demands therefore on account of any injury, including but not limited to the death of the student/participant or damage to property, arising out of or relating to the event(s) caused or alleged to be caused in whole or in part by the negligence of the Releasee or otherwise.

4. I hereby acknowledge that the activities of the event(s) are very dangerous and involve risk of serious injury and/or death and/or property damage. The Releasor also expressly acknowledges that injuries received may be compounded or increased by negligent rescue operations or procedures of the Releasee.

5. The Releasor further expressly agrees that the forgoing 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(s) 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.

6. The Releasor executes this waiver and release. If, despite this release, the Releasor makes a claim against the Releasee, the Releasor will reimburse the Releasee for any money which they have paid to the student/participant, or on their behalf, and hold them harmless.

7. By providing my email address I agree to receive emails from AHMA. I grant Art Hinkelbein Martial Arts Academy LLC the right to take, edit, alter, copy, exhibit, publish, distribute and make use of any and all pictures or video taken of the aforementioned participant to be used in and/or for legally promotional materials including, but not limited to, newsletters, flyers, posters, brochures, advertisements, fundraising letters, annual reports, press kits and submissions to journalists, websites, social networking sites and other print and digital communications, without payment or any other consideration.

I have read this release and waiver of liability, assumption of risk and indemnity agreement, fully understand it's terms, understand that I have given up substantial rights by agreeing to these terms and conditions and have agreed freely and voluntarily without any inducement, assurance or guarantee being made to me and intend my agreement to be complete and an unconditional release of all liability to the greatest extent allowed by law.