AMERICAN SCHOOL OF KARATE & JUDO LLC
13803 Industrial Road, Omaha, NE 68137
LIABILITY RELEASE AND WAIVER FORM (MINOR)
Minor's Name(s):
Address: , , ,
Participation Authorization & Liability Release: I, as parent or legal guardian of , a minor or minors (hereinafter, whether one or more, referred to collectively as "Minor"), hereby grant the permission necessary to allow Minor to utilize the equipment and participate in the martial arts instruction courses (use of such equipment and participation in such courses being referred to collectively herein as the “ASKJ Services”) provided by Hilson 21, LLC d/b/a American School of Karate & Judo, a Nebraska limited liability company (“ASKJ”). In consideration of ASKJ allowing Minor to participate in the ASKJ Services, and for other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, I, in my own behalf and on behalf of Minor, further agree to release and to hold harmless ASKJ and its members, managers, officers, representatives, agents, landlord, volunteers, and employees and each of its and their respective successors, assigns, heirs and beneficiaries (hereinafter collectively the "Released Parties") from any and all liability for negligence or any other claim, judgment, loss, liability, cost and expenses (including, without limitations, attorney's fees and costs) arising out of or connected with Minor’s participation in the ASKJ Services, including any claim arising out of or connected with any illness or injury (minimal, serious, catastrophic and/or death) that Minor may incur or sustain while participating in the ASKJ Services. I further expressly agree to indemnify and hold harmless the Released Parties against loss from any further claims, demands or actions that may subsequently be brought by Minor or by any other persons on the account of damages of any character resulting to Minor in any way from the ASKJ Services. I further agree to reimburse and to make good to the Released Parties any loss, or costs the Released Parties may have to pay as a result of any such action, claim, or demand.
Appearance Agreement: I understand that ASKJ, from time to time, produces promotional material relating to its business. I understand that as a participant and/or a spectator at ASKJ that Minor may be included in videotapes or photographs taken at ASKJ. Therefore, without reservation or limitations, I, in my own behalf and on behalf of Minor, hereby assign, transfer and grant to ASKJ, its successors, assignees, licensees, sponsors, any television networks, and all other commercial exhibitors the exclusive right to photograph and/or videotape Minor and to utilize such videotapes and photographs and Minor's name, face, likeness, voice and appearance in advertising and promoting ASKJ. I further understand that neither ASKJ nor any third party is under any obligation to exercise any of the foregoing rights, licenses and privileges.
Medical Release: I, in my own behalf and on behalf of Minor, acknowledge and agree that such participation subjects Minor to the possibility of physical illness or injury (minimal, serious, catastrophic and/or death) and that I, in my own behalf and on behalf of Minor, acknowledge that Minor is assuming the risk of such illness or injury by participating in the ASKJ Services. In the event of such illness or injury, I authorize ASKJ to obtain necessary medical treatment for Minor and hereby, in my own behalf and on behalf of Minor, release and hold harmless the Released Parties in the exercises of this authority. I further acknowledge and understand that I will be responsible for any and all medical and related bills that may be incurred on behalf of Minor for any illness or injury that Minor may sustain while participating in the ASKJ Services.
If any provision of this Liability Release and Waiver Form is determined by any court to be invalid, then such invalidity shall not affect any other provision of this Liability Release and Waiver Form to which effect reasonably can be given without such invalid provision; and for such purpose the provisions of this Liability Release and Waiver Form shall be severable from one another.
I, in my own behalf and on behalf of Minor, am aware that this Liability Release and Waiver Form releases the Released Parties from liability and contains an acknowledgement of my voluntary and knowing assumption of the risk of injury or illness. I, in my own behalf and on behalf of Minor, have signed this document voluntarily and of my own free will.
Signature of Parent or Legal Guardian: