Name *

First Name

Last Name

Phone

(###)

###

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Emergency Contact *

First Name

Last Name

Emergency Phone

(###)

###

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How did you hear about NYC Aikido Kokikai?

Google

Social Media

Friends & Family

Other

Understanding Risks *

By joining any activity organized or sponsored by NYC Aikido Kokikai, I agree to the following for myself or, if applicable, as the parent or guardian of the minor child named below. I understand that each activity comes with some risks, which might be due to my actions, the actions of others, or the conditions of the facility. I’m aware that participating in these activities can involve physical risks, including the chance of serious injury, permanent disability, paralysis, or even death.

Yes, I understand

Release from Liability *

I promise not to hold NYC Aikido Kokikai or any of its members responsible for any claims, actions, losses, costs, or damages that might come up from participating in these activities, even if it's due to the club's negligence. If I, the Minor, or anyone on our behalf makes a claim against any member of the NYC Aikido Kokikai community, I agree to cover any resulting loss, cost, expense, damage, or liability, including attorney fees or other legal costs.

Yes, I agree

Media Consent *

I understand that NYC Aikido Kokikai might take pictures or videos during activities and classes. I agree, for myself or the Minor, that NYC Aikido Kokikai can use these photos and videos for promotional purposes. I acknowledge that NYC Aikido Kokikai will own these materials.

Yes, I understand

Completed on Behalf of a Minor *

Yes

No