Aoyama Doja and Traditional Karate Research Institute of Virginia Agreement and Release

Name:___________________________________________________________Age:____________

In consideration of my participation in Traditional Karate Camp,

1. I release the Traditional Karate Research Institute of Virginia (TKRI-VA), Aoyama Dojo, The Kitterman estate, the Simpson estate, and A & A and all their officers, directors, employees, instructors and representatives from all liability and injury claims that I may have against any of them for my participation in Traditional Karate Camp.

2. I accept all financial obligations incurred for medical, hospital, and other expenses related to injury resulting from my participation in Traditional Karate Camp.

3. I release and hold harmless all the officers, directors, employees, instructors, and representatives from all liability and claims for these expenses described in paragraph two hereof.

4. I authorize the following named person to act in any matter requiring my consent, including their retaining on my behalf medical attention and hospitalization and related services, should I be unable to give such consent.

     Name: ___________________________________________________

    

     Address: __________________________________________________

     Phone: _____________________________________________________

5. I understand that HIV and AIDS are a concern in today’s society. It is more than probable that in this day and age, we will come into contact with a person who is either HIV-positive, has AIDS, or both. Current medicine states that it is only through bodily fluid that the diseases can be transferred. We do not administer blood tests, or invade privacy. Therefore, we will treat any injuries involving blood seriously. On rare occasions, someone may have an injury that results in an open wound--(ie stubbed toe, broken fingernail, fingernail scratch). If such incident occurs, the student will be excused from the floor, and an instructor or assistant instructor will provide any supplies, ie band-aid, tape, gauze, ointment, etc. If any blood gets on the floor, the area will be wiped clean with disinfectant. The student will be able to rejoin the class once the wound has been treated and the bleeding has been stopped. By signing this, I understand that a great amount of care will be taken to insure my health against HIV and/or AIDS. I understand the TKRI-VA staff will do all in its power to keep conditions safe. I again realize, however, that although a rarity, accidents happen--especially in contact sports. I hereby release the TKRI-VA, Aoyama Dojo, A&A, and all previously stated persons, under previously stated conditions, from all responsibility from any sport-related injury or accident involving HIV/AIDS.

6. I the undersigned understand and fully recognize the risk of physical injury from participating in traditional Karate. And that although the utmost care and safety will be of concern, karate can cause injuries and on rare occasions, fatal injuries. With such knowledge and recognition, I hereby assume all risk of such injury resulting from my participation. If I bring legal action in violation of the terms of this agreement and release, I agree to pay the reasonable attorney fees and costs of the party against whom action is brought.

Name________________________________________________  Date_________

Participant’s Signature:________________________________________________

Guardian Signature if Under 18:_________________________________________

Address: _____________________________________________________________