Great Lakes Aikido LLC

PARTICIPANT INFORMATION AND WAIVER OF LIABILITY

INSTRUCTIONS

Please read this document in its entirety and complete all applicable fields. If registering online, many fields are automatically filled in from the visitor or membership registration form where this document is attached but a few must be completed in the form itself. Please ensure all information is complete and accurate.

Completion of the registration form and acceptance of this WAIVER OF LIABILITY are required to participate in classes and events hosted by GREAT LAKES AIKIDO LLC. We cannot provide services without a waiver on file.

PARTICIPANT INFORMATION

All information is required:

• Legal Name: {name}
• Date of Birth: {dob}, participants under 18 years of age MUST have the signature of a custodial parent or legal guardian.
• Street Address: {address}
• Email Address: {email}
• Mobile Phone: {phone}
  please do not send SMS notifications to this number.

GENERAL HEALTH

• Participant's general level of health:
  Excellent, Good, Fair, Poor
• Participant has medical conditions of which the instructors should be aware:
  No, Yes
  If "Yes", please provide details in the membership form or contact your instructor to discuss.

EMERGENCY CONTACT INFORMATION

If Participant is under 18 years of age, this MUST be a custodial parent/legal guardian and MUST be completed:

• Emergency Contact: {contact_name}
• Relationship to Participant: {contact_relation}
• Emergency contact mobile phone: {contact_phone}
  Required if Participant is under 18 years of age:
• Emergency Contact Email Address:
• Emergency Contact Street Address:
  Same as Participant.
  - or -
  Street Address:

RELEASE OF ALL LIABILITY AND INDEMNIFICATION AGREEMENT

1. DEFINITIONS

For the purposes of this document:

1. The legal entity “GREAT LAKES AIKIDO LLC”, a limited liability company organized under the laws of the State of Illinois, may be referred to as “Great Lakes Aikido”, “GLA”, or “the Company”. These terms are used interchangeably throughout this document and shall have the same legal effect.
2. The terms “Participant” or “Member” refer to the individual identified in the PARTICIPANT INFORMATION section of this document, and who will be taking part in classes, events, or other activities offered by GLA. “Participants” are understood to be attending occasional training events or seminars while “Members” are Participants who enter an ongoing relationship with GLA to take part in regular classes.
3. The term “Guardian” refers to the custodial parent or legal guardian who is signing this document on behalf of a Participant, if the Participant is a minor child under the age of 18.
4. The term “Signee” refers to the individual executing this agreement. The Signee may be either:
   1. an adult Participant or Member, defined as the individual identified in this contract who is registering for or participating in classes, events, or other activities offered by the Company; or
   2. the adult Guardian signing this document on behalf of their minor Participant under the age of 18.
5. The term “Releasees” refers to GREAT LAKES AIKIDO LLC and also includes its owners, managers, instructors, members, students, event participants, affiliates, promoters, lessees of premises used to conduct martial arts events or programs, 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.

2. AGREEMENT

1. In consideration of being permitted to participate in any way in the programs and events offered by Great Lakes Aikido, the Signee agrees for themself and/or their minor child Participant that:
   1. Prior to participating in any martial arts activity or event, the Participant should inspect the facilities and equipment to be used, and if they believe anything is unsafe, they should immediately advise the officials of such conditions and refuse to participate. The Signee understands and agrees that, if at any time, Participant feels anything to be UNSAFE; they will immediately take all precautions to avoid the unsafe area and REFUSE TO PARTICIPATE further.
   2. The Signee fully understands and acknowledges that:
      1. There are risks and dangers associated with participation in martial arts events and activities which could result in illness, bodily injury, partial and/or total disability, paralysis, and death.
      2. The social and economic losses and/or damages, which could result from these risks and dangers described above, could be severe.
      3. 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.
      4. There may be other risks not known or not reasonably foreseeable at this time.
   3. The Signee accepts and assumes such risks and responsibility for the losses and/or damages following such illness (including viruses or other communicable diseases that may be contracted through participation), injury, disability, paralysis or death, however caused and whether caused in whole or in part by the negligence of GLA and the Releasees.
2. THE SIGNEE HEREBY RELEASES, WAIVES, DISCHARGES, AND COVENANTS NOT TO SUE GREAT LAKES AIKIDO LLC AND OTHER RELEASEES from all liability to the Signee and/or Participant, their 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 illness or injury, including but not limited to the death of the participant or damage to property, arising out of or relating to the events(s) alleged to be caused in whole or in part by the negligence of the Releasees, or otherwise.
3. THE SIGNEE HEREBY ACKNOWLEDGES THAT THE ACTIVITIES offered by GREAT LAKES AIKIDO LLC ARE VERY DANGEROUS and may involve the risk of serious injury, illness, and/or death and/or property damage.
   1. The Signee also expressly acknowledges that INJURIES RECEIVED MAY BE COMPOUNDED OR INCREASED BY NEGLIGENT RESCUE OPERATIONS OR PROCEDURES OF THE RELEASEES.
   2. The Signee 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 activities are conducted and that if any portion is held invalid, it is agreed that the balance shall, notwithstanding continue in full legal force and effect.

3. ACCEPTANCE AND SIGNEE SIGNATURE

Signed:

Date: {sign_date}

Revision 003
Last Updated: 2025-09-14