Loading...

Student Release Form Alpha Martial Arts (2022)


  • Make Required

  • Make Required

  • Make Required

  • Make Required

  • Make Required

  • Make Required

  • Make Required

  • Make Required

  • Make Required

  • Make Required

  • Make Required

  • Make Required

  • Make Required

  • Make Required
  • PARTIES AND PURPOSE OF DOCUMENT

    The safety of participants and spectators at every Alpha Martial Arts (“AMA” and “school”) class, training session, tip test, examination, graduation, performance, and other event (“event”) is the school’s highest priority.  While AMA makes good faith efforts to implement safety measures at all such events, under no circumstances is the school able to guarantee the safety of participants and spectators.  This Assumption of Risk, Waiver and Release Agreement (“Student Release Form”) defines the relationship between AMA and the above-named Student and/or the undersigned on the Student’s behalf, and discusses all related terms, including Student representations and responsibilities.

     

    NOTICE OF AND CONSENT TO PHYSICAL CONTACT

    The practice of martial arts entails physical activity, and, routinely, physical contact with others.  Complete training of the martial arts taught at AMA involves a wide variety of techniques, including strikes, kicks, throws, grappling, sparring and other contact-based physical skills.  While learning and practicing these skills, students may experience contact at any portion of their body.  A student’s chest, buttocks, groin and any other body part may be inadvertently or incidentally contacted by part of the training partner’s body while learning or practicing such skills, typically while performing a martial arts technique that targets another portion of the body.  Students are expected to conduct themselves appropriately at all times to ensure optimal training results for everyone.  Should any student feel that a training partner has or is engaging in contact beyond the scope of training, including by use of excessive force, or if a student feels uncomfortable with any training activity, that student has the right to withdraw from the partner pairing and/or activity.  The Student hereby confirms that he, she or they (1) understands the nature of physical contact in martial arts training; (2) consents to such contact; and (3) recognizes that, if ever any activity or the conduct of any party is beyond the scope of training or otherwise makes the Student uncomfortable, he, she or they may immediately withdraw from the uncomfortable situation.  The Student further agrees to always abide by school etiquette, including as set forth in the AMA student creed.  Accordingly, the Student shall not conduct himself, herself or themselves inappropriately, unreasonably, or in any manner that takes advantage of the physical contact intrinsic to martial arts training.

     

    NOTICE AND CONSENT CONCERNING INSTRUCTORS

    AMA seeks to make use of professional instructors who are highly trained, experienced and accomplished in their martial art.  Where a professional instructor is unavailable for a particular class or other training, AMA shall provide a junior instructor, senior student or guest instructor to teach.  The choice of instructors is left to the sole discretion of the school.  The Student and the undersigned understand that he, she or they may not always have the ability to work with their preferred instructor.  As to all instructors provided by AMA, the Student agrees to (1) seek to learn from whomever is teaching; (2) demonstrate respect, receptivity and courtesy to the instructor; and (3) otherwise conduct himself, herself or themself in accordance with school etiquette, including as set forth in the AMA student creed.

     

    AUTHORITY TO RENDER ASSISTANCE

    Subject to any limitation noted below, the Student and the undersigned hereby authorize AMA to attempt to render immediate assistance to and/or facilitate emergency medical or other health care for the Student.  The Student and the undersigned understand that, while the school’s instructors and other personnel are not licensed medical professionals, some have relevant but limited skills concerning First Aid, CPR and acute injury response which may benefit the Student before an EMT or other trained medical professional who may be summoned arrives, or before the Student otherwise receives treatment from a health care professional.  The Student and the undersigned authorize AMA to attempt to assist the Student in any circumstance where a school representative reasonably believes that prompt action may be necessary or beneficial.  By granting this authorization, the Student and the undersigned assume responsibility for all decisions made by AMA, provided such decisions are reasonable under the circumstances.

     

    Limitations to Assistance:_________________________________________________

    Information of Medical Significance:_________________________________________


  • Make Required

  • Make Required
  • NOTICE AND MANDATE CONCERNING COVID-19

    COVID-19 is a highly contagious respiratory disease caused by the novel coronavirus.  The virus can cause long-term medical problems and death, regardless of age.  Though AMA regularly sanitizes its premises and equipment, limits in-person attendance at school events, and monitors instructors, employees and volunteers concerning compliance with COVID-19 safety protocols pursuant to Washington law and CDC guidelines, the school cannot guarantee that the Student, the undersigned, and the Student’s guests will not become exposed or infected while attending an AMA event.  As mandated by the current Revised Local Health Order (“the Order”) governing public health throughout King County, Washington, https://kingcounty.gov/depts/health/covid-19/current-guidance/~/media/depts/health/communicable-diseases/documents/C19/LHO-proof-of-vaccination.ashx, AMA requires all students and students’ guests who are 12 years of age and older to verify they are “fully vaccinated” before attending any in-person school event.  Per the Order, a person is considered fully vaccinated fourteen (14) days following receipt of all required doses of an FDA-approved COVID-19 vaccination (i.e., two doses of the Moderna or Pfizer-BioNTech vaccines, or one dose of the Johnson & Johnson vaccine), or a WHO-authorized COVID-19 vaccine series.  Vaccine verification may be established by producing a CDC COVID-19 Vaccine Record Card, photo or photocopy of such Card; the original, a photo or photocopy of a health care provider’s official immunization record; a QR or digital copy of one’s COVID-19 vaccination record, as generated by WAverify (https://waverify.doh.wa.gov/) or the Clear app; or a printed certificate or digital record from MyIR Mobile (https://myirmobile.com/washington) or a similar app.  Alternatively, unvaccinated individuals must provide to AMA digital or printed documentation from a testing agent (e.g., a laboratory, health care provider or pharmacy) of a negative FDA-authorized or approved molecular (e.g., PCR) test or an FDA-authorized antigen (e.g., rapid) test administered within the previous 72 hours.  The Order further provides that self-administered antigen tests will not be accepted, and that medical and religious vaccine exemptions are not accepted in place of vaccine verification or documentation of a timely negative COVID-19 test result.  The Order does not apply to students under 12 years of age.

     

    STUDENT REPRESENTATIONS CONCERNING COVID-19

    In addition to complying with the above-referenced Revised Local Health Order, the Student makes the following representations concerning general health status, COVID-19 exposure, and recent travel, which are true and correct to the best of his, her or their knowledge:

    • I am not experiencing any symptoms of illness such as cough, shortness of breath or difficulty breathing, fever, chills, muscle pain, sore throat, or sudden loss of taste or smell.
    • I have not been exposed to a person with a suspected or confirmed case of COVID-19, or, I work in a health care facility and have properly used “personal protective equipment” (“PPE”) at all times while working with patients, or if I have been exposed to a person with COVID-19, I have observed and completed quarantine in accordance with CDC quarantine guidance (https://www.cdc.gov/coronavirus/2019-ncov/your-health/quarantine-isolation.html).
    • I have not been diagnosed with COVID-19, or, if I have been diagnosed with COVID-19, I have been released from isolation in accordance with CDC isolation guidance per the preceding hyperlinked instruction.
    • I have not traveled outside the United States in the last ten (10) days; or, if I have traveled internationally, I have completed the required testing or quarantine protocol in accordance with CDC international travel requirements (https://www.cdc.gov/coronavirus/2019-ncov/travelers/international-travel-during-covid19.html).
    • I have not traveled to a highly impacted COVID-19 area within the United States within the last ten (10) days; or, if I have traveled domestically to such an area, I have completed the previously referenced testing or quarantine protocol in accordance with CDC travel requirements.
    • I understand that I must wear a mask at all times at every in-person AMA event, and that my guests who are over the age of two (2) also must comply with the COVID-19 protocols identified in this document.
    • I agree to immediately notify AMA if ever my status as to any of the foregoing representations changes.
    • I specifically agree to immediately notify AMA if ever I test positive for COVID-19, am diagnosed with COVID-19, or have a known or suspected exposure to someone who has COVID-19.
  • STUDENT RESPONSIBILITIES

    The safety of every student, spectator and other attendee at AMA events is a matter of shared responsibilities.  In addition to the school’s reasonable care and good faith efforts to implement safety measures at all its events, students also must uphold key duties.  As noted above, the Student at all times must comply with AMA’s student creed, which is adopted by reference as though set forth fully herein.  The Student must also exercise reasonable care to ensure his, her or their safety, as well as the safety of others in attendance at every school event.  Among other practices, this duty requires the Student to give those who are training nearby adequate physical space to avoid being accidentally struck by the Student, another martial arts practitioner, or martial arts equipment.  Compliance in this regard is particularly important when anyone is training with or otherwise handling a weapon.  It is incumbent on the Student to evaluate every situation mindful of his, her or their current skill level, physical condition and any limitation.  If ever the Student believes that a particular exercise, drill or other school activity will subject him, her, them or anyone else to harm, it is both the Student’s right and responsibility to withdraw from the activity.  Where an instructor inquires as to the reason for the withdrawal, the Student shall identify such reason(s).  Additionally, adult students, minor student’s parent(s) and/or guardian(s), and the undersigned must notify their guests who attend any AMA event of the safety protocols and responsibilities identified throughout this document.  Every school event attendee must exercise reasonable care to ensure his, her or their safety, as well as adhere to all COVID-19 protocols identified above.

     

    ASSUMPTION OF RISK AND DUTY TO NOTIFY GUESTS

    There are two risks the Student, the undersigned, and their guests assume while attending any AMA event.  The first risk that all attendees assume (i.e., accept) relates to the nature of martial arts, which is a potentially dangerous activity.  While bumps, bruises, scrapes, scratches and soreness are commonplace, more serious injuries are possible, such as sprains, strains, twists and other soft-tissue injuries, as well as fractures and other hard-tissue injuries.  Not all students experience injuries, but the potential always exists.  Students and minor students’ parent(s) and/or guardian(s) thus assume the risk that such outcomes are possible.  Similarly, despite implementation of safety measures and use of protective equipment, there remains the remote possibility of crippling, other permanent condition or death, though such outcomes are highly unanticipated.  Beyond the potential for participants to experience any of the conditions noted above, AMA cannot out rule the possibility that spectators at in-person school events could sustain any of the above-referenced outcomes by virtue of physical proximity to the practice or performance of martial arts.  As such, students, minor students’ parent(s) and/or guardian(s), and all students’ guests assume the risk of these potential results.  The second risk assumed relates to the potential for exposure to the COVID-19 virus, as addressed above.  Though the school implements reasonable measures to prevent in-person attendees from being exposed to COVID-19, students, minor students’ parent(s) and/or guardian(s), and students’ guests assume the risk of potential exposure and infection, along with the possibility of resulting illness, disability, and/or death.  As relates to both risks identified in this section, the Student and the undersigned voluntarily assume each risk, and further agree that it is incumbent on them to notify their guests that, by attending an in-person AMA event, such guests also assume both risks.  As noted above, AMA emphasizes that school event attendees must exercise reasonable care to ensure their safety, as well as adhere to all above COVID-19 protocols.

     

    WAIVER AND RELEASE OF LIABILITY, INCLUDING AS RELATES TO COVID-19

    It is expressly understood and agreed that, in consideration of the martial arts training, related services and resources that AMA provides, the Student and the undersigned, as well as their heirs, successors, executors, administrators and assigns, voluntarily waive the right to pursue legal action, covenant not to sue, voluntarily release, forever discharge, and agree to indemnify and hold harmless Alpha Martial Arts, LLC; Christopher M. Herrman individually; the Herrman marital community; and AMA’s instructors, employees, volunteers, agents and other representatives, from and against any and all claims, costs, damages, demands, expenses (including reasonable attorney’s fees, if any, incurred on the Student’s behalf), liabilities, or losses of any kind or nature whatsoever, which the Student and the undersigned may have or which subsequently may accrue as a result of attendance at and/or participation in any AMA event.

     

    PHOTO/VIDEO RELEASE AND DUTY TO NOTIFY GUESTS

    AMA takes photographs and videos of students in class and at other school events.  The Student and the undersigned authorize AMA and its agents to photograph, record, and use the likeness of the Student and any of his, her or their guests.  Concerning all such photos and videos, the Student and the undersigned grant AMA and its agents permission as well as the absolute and irrevocable right to (1) copyright in AMA or any other name they may select; (2) post, re-post, publish, re-publish, and otherwise use and re-use the same, in whole or in part, separately, or in conjunction with any other medium now or here after known, and for any purpose whatsoever; and (3) reference the Student’s name, as well as the student’s parents’ or guardians’ and/or other guests’ names.  The Student and the undersigned further agree that that he, she or they have no rights to the photos and videos taken by AMA and its agents, and that all such rights belong to the school and said agents.  The Student and the undersigned thus waive any right to or claim for compensation regarding such photos and videos, release and discharge AMA and its agents from any and all related claims and demands, and further acknowledge that the entirety of this photo/video waiver and release is binding upon his, her or their heirs and assigns.  Because this provision applies to the Student’s and the undersigned’s guests at all in-person AMA events, it is incumbent on the Student and the undersigned to notify their guests accordingly.

     

    INSUBORDINATION

    If the Student demonstrates repeated failures or a single egregious failure to comply with his, her or their responsibilities identified in this Student Release Form, including but not limited to upholding the AMA student creed, complying with all COVID-19 mandates herein, and refraining from conduct that takes advantage of the physical contact intrinsic to martial arts training, such failure(s) shall jeopardize the Student’s ability to continue to train at AMA.  Minor students’ parents and guardians must explain to their child(ren) all student responsibilities specified in this document.

     

    DISPUTE RESOLUTION VIA BINDING ARBITRATION

    Should any dispute arise between AMA and the Student and/or the undersigned, including as relates to interpretation and/or enforcement of any provision in this document, the parties agree that the dispute shall be resolved via binding arbitration by a “local neutral” Arbitrator from either Judicial Arbitration and Mediation Services of Seattle (“JAMS,” www.jamsadr.com) or Judicial Dispute Resolution of Seattle (“JDR,” https://jdrllc.com).  Arbitrators who serve at JAMS and JDR are former state and federal court judges with extensive legal experience.  The parties shall cooperate in selecting an agreed Arbitrator from either firm based on the Arbitrator’s availability.  Binding arbitration shall be scheduled and conducted with the agreed Arbitrator within a reasonable time after the dispute arises.  All fees and costs charged by the Arbitrator shall be split equally between the parties and paid for in accordance with JAMS’ or JDR’s client policies.

     

    ATTORNEY’S FEES TO PREVAILING PARTY

    If the Student or the undersigned breach this agreement by filing an action in any Court of law, despite the above provision requiring the parties to submit all disputes to binding arbitration, the parties authorize the Court to enter an Order referring the matter for final resolution to either JAMS or JDR, as established above.  The parties further agree that all costs and expenses incurred by the prevailing party for the purpose of responding to such legal action shall be paid in full by the non-prevailing party.  The payment of costs and expenses owed by the non-prevailing party include the prevailing party’s reasonable attorney’s fees and related charges, which shall be paid within a reasonable time.

     

    DURABILITY AND SEVERABILITY

    This document is effective with no expiration from the date of signing.  Where the Student visits the school, commences training, or otherwise participates in any AMA event before the date on which this Student Release Form is signed, the terms herein apply retroactively to the date of the Student’s initial school event.  If any above provision or portion thereof is deemed invalid or unenforceable in binding arbitration, the remainder of this document shall remain valid and enforceable, and the invalid provision or portion thereof shall be considered stricken.

     

    CERTIFICATION

    I certify that I have read this Assumption of Risk, Waiver and Release Agreement (i.e., Student Release Form) and fully understand and agree to its terms.

     

    ________________________________________

    Signature*

    ________________________________________

    Print Name

    ________________________________________

    Date

    *If you are submitting this form electronically with a typed name on the Signature line, you understand and further certify that you have freely and voluntarily executed this document and that your typed name in the Signature field constitutes a legally binding signature.


  • Make Required
  • Assumption of Risk, Waiver and Release Agreement (i.e., Student Release Form) Acknowledged and Agreed by: 

  • I agree to the Terms and Conditions

    This must be on-file prior to in-person attendance.



 

Title

Text