SIOUX LEGACY MARTIAL ARTS
1170 Second Ave. NE • Sioux Center, IA 51250 • 712-215-8388 • info@siouxlegacy.com
Visit us at www.siouxlegacy.com
WAIVER, RELEASE OF LIABILITY & ASSUMPTION OF RISK
THIS AGREEMENT MUST BE SIGNED BY ALL PERSONS WHO WISH TO PARTICIPATE IN SIOUX LEGACY MARTIAL ARTS CLASSES, EVENTS, OR ACTIVITIES.
In consideration of participating in the classes, events, and/or activities of Sioux Legacy Martial Arts, I certify that I have read this document, understand its provisions, and agree to its terms which constitute legally binding consent, assumption of risk, waiver of claims, and indemnity for participating in activities at Sioux Legacy Martial Arts.
- I recognize and acknowledge that martial arts training is an activity that involves physical contact and that participation might result in serious injury, including but are not limited to, falling, slipping, muscle or skeletal injuries, collisions, respiratory issues, strains, sprains, fractures, dislocations, heart attack, stroke, heat stress, or even death.
- I recognize and acknowledge that such risk may be due to not only my own actions, but also the action, inaction or negligence of others, the regulations of participation, or the conditions of the premises, or of any of the equipment used.
- I recognize this release shall be binding not only for me, but upon my heirs, administrators, executors, successors, and assignees regarding Sioux Legacy Martial Arts and its programs.
- I recognize and acknowledge the use of the Sioux Legacy Martial Arts facility does not permit the use of equipment owned and operated by Studio R Acrobatics & Tumbling.
- I consent to the participation in such activities with full knowledge that the activities may be hazardous.
- I accept full responsibility for any risks of injury, loss, or property damage.
- I agree to pay for all damages to the facilities of Sioux Legacy Martial Arts caused by any negligent, reckless, or willful actions by me or my family.
- I agree to indemnify, defend, hold harmless, discharge and release Studio R Acrobatics & Tumbling (Lessor), Dan Reid (Building Owner), Sioux Legacy Martial Arts, their agents, employees, and officers from all liability, claims, causes of action, damages, judgments, cost of expenses, including attorney fees and other litigation costs, which may arise from my or my family’s use of or presence upon the facilities of Sioux Legacy Martial Arts.
- I certify that I am in good health and have no physical, medical, mental, or emotional impairments, conditions or concerns that might jeopardize or affect my safety, or the safety of others, related to my participation in activities.
- If prescription or over the counter medications are required, I understand that I should confirm with a medical provider whether the medications will impact participation in activities at Sioux Legacy Martial Arts.
- I understand that I should not participate in activities at Sioux Legacy Martial Arts while under the influence of any medication that may impact my ability to safely participate.
- I grant permission in case of injury to have a doctor, nurse, athletic training, or other emergency medical personnel provide me with medical assistance or treatment for such injury.
- I agree that all expenses arising from an accident or injury to myself or my property, including but not limited to, emergency transport; emergency medical services; medical treatment; and damage or loss to property are my responsibilities.
- I have obtained and agree to use my personal medical insurance as primary medical coverage if an accident or injury occurs.
- I agree to notify Sioux Legacy Martial Arts employee(s)/staff member(s) of any existing medical condition or medication that could affect my ability to fully participate in activities. If any medical attention is needed, and I am unable to provide consent on my own behalf, I consent to emergency medical treatment and grant Sioux Legacy Martial Arts and its employee’s full authority to take whatever actions they may consider to be warranted under the circumstances concerning my health and safety. This includes, but is not limited to, the authority and permission to arrange/provide transportation, approval for a hospital, medical treatment facility, and/or health care provider to provide medical exams, testing, medical treatment, and any medical procedures immediately necessary and advisable in the interest of my health and well-being, all at my expense.
- I release, waive, discharge and covenant not to sue, Sioux Legacy Martial Arts., its affiliated organizations and governing bodies, their officers, instructors and personnel, other members of the organizations, participants, supervisors, coaches, sponsoring organizations or their agents, and if applicable, owners and leasers of the premises from any and all liability to the undersigned, his or her heirs and next of kin for any and all claims, demands, losses and damages which may be sustained and suffered on account of injury, including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the releasees or otherwise.
- I agree that I have been given the opportunity to seek independent legal advice prior to signing this agreement.
- This agreement contains the entire agreement between the parties to this agreement and the terms of this agreement are contractual and not a mere recital.
- This agreement will be governed by and construed in accordance with the laws of the State of Iowa.
I HAVE READ THE ABOVE WAIVER, RELEASE OF LIABILITY, AND ASSUMPTION OF RISK. I FULLY UNDERSTAND ITS CONTENTS, AND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT. I HEARBY SIGN IT VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY.
Participant OR Parent/Guardian Signature: