Waiver For? MySelf My Child/Dependent

How did you Hear About Us?
Do you have any Medical Concerns?

No/Yes(Please List) Yes No

(if yes, you must submit a doctor's note specifically stating you are fit to participate in a high intensity fitness workout)
Please list your medical concerns

I confirm that I am the legal guardian and authorize him/her to join YAMAJI DOJO MARTIAL ARTS & FITNESS .




Students are required to dress in clean uniforms/ appropriate gym attire.  We do all classes in bare feet/socks on the mats or wear non marking indoor shoes in the fitness studio. NO chewing gum or dangling jewelry. Hair should be pulled neatly and securely away from the face so that is stays up for the entire workout. Girls should not wear bows or other large hair ornaments that may cause discomfort during activity. Jewelry should not be worn during classes. PLEASE LEAVE JEWELRY ARTICLES AT HOME. This facility's staff will not be responsible for ANY items that may be lost or stolen. Be sure your student's personal items are marked with their name.  PLEASE BRING WATER. Water is sold at the Dojo if needed.


The above applicant wishes to participate in training opportunities presented by the Yamaji Dojo Martial
Arts & Fitness Centre. Applicant understands that the training activities offered by the Yamaji Dojo Martial
Arts & Fitness Centre, and other activities associated therewith, may by physically, emotionally and
psychologically challenging, and that participation in such activities may involve physical contact with
others, may involve use of and proximity to martial arts tools and other apparatus, and may involve mental
awareness and exploration exercises, and that Applicant may thereby be exposed to risk of injury, mental
distress, damage, or loss due to the nature of such activities. Applicant hereby represents that applicant is
physically, emotionally, and psychologically fit to participate in such activities. Applicant understands that it
is solely the Applicants responsibility to decide which activities, if any, Applicant wishes to participate in and
Applicant understands that, at all times, Applicant has the option to refrain or withdraw from any activity
whatsoever. By participating in any such activity, Applicant chooses to assume fully any and all risks and
consequences relating thereto.
Applicant hereby releases and discharges Yamaji Dojo Martial Arts & Fitness Centre, its principles, officers,
members, employees, volunteers, affiliates, agents, successors, and assigns; Phillip M. Yang, his agents,
heirs, executors, administrators, successors, instructors and assigns; and any other person directly or
indirectly concerned with Applicants participation in any activities related directly or indirectly to the training
offered by Yamaji Dojo Martial Arts & Fitness Centre from any responsibility or liability of any kind to
Applicant for any injury, damage, or loss of any kind that may occur directly or indirectly as a result of such
Applicant hereby agrees to indemnify and hold harmless Yamaji Dojo Martial Arts & Fitness Centre and
covenants not to bring any action, or to directly or indirectly make any claim or demand of any kind, for any
injury, damage, or loss of any kind that Applicant or any other persons may sustain directly or indirectly
from such participation, and Applicant hereby waives any right to bring any such action or make any such
claim or demand, and Applicant agrees to cause to be paid to them or their legal representatives any legal
costs or fees incurred by them in connection therewith.
Applicant hereby agrees to allow Yamaji Dojo Martial Arts & Fitness Centre to use any or all photographs,
videos, interviews, written or oral statements in it promotional, marketing, and commercial campaigns. This
may include, but is not limited to, video productions or instructional videos; video productions for
rebroadcast as commercial advertisements, news shows, public service announcements or public television
shows; or any related video production used by Yamaji Dojo Martial Arts & Fitness Centre. Applicant
hereby waives all interest in any such productions and agrees to allow Yamaji Dojo Martial Arts & Fitness
Centre to use Applicant’s likeness in any such videos, photos. Any of the Internet advertisements and any
other media presentations. Yamaji Dojo reserves the right to refuse entry and eject persons under the
influence of drugs or alcohol, who are disorderly, do not maintain an appropriate dress code, or engage in
inappropriate behavior, vandalism or evade admission. Yamaji Dojo
Applicant understands that medical treatment will not be made formally available. Applicant agrees to
assume full responsibility for any risk or consequences associated with seeking or accepting, or failing to
seek or accept any medical treatment.
Applicant makes all covenants, waiver, releases, indemnifications, representatives, and other commitments
contained herein knowingly and voluntarily agree that they are contractually binding on Applicant and
Applicant’s heirs, executors, administrators, successors, instructors and assigns. Applicant acknowledges
that Applicant has read this agreement and understands it in its entirety.

COVID19 Acceptance of Risk Document–Yamaji Dojo Martial Arts & Fitness Centre 693232NB Inc.


ASSUMPTION OF RISKS. I understand that the World Health Organization has classified the COVID-19 outbreak as a pandemic. I further understand that COVID-19 is a highly contagious and dangerous disease, and that contact with the virus that causes COVID-19 may result in significant personal injury or death.

I understand and accept that while Yamaji Dojo Martial Arts & Fitness 693232NB Inc has undertaken the required steps as indicated by the department public health to lessen the risk of transmission ofCOVID-19 in connection with the programs and services the Yamaji Dojo Martial Arts & Fitness 693232NB Inc is not responsible in any manner for any risks related to COVID-19 in connection with the club.

I am fully aware and accept all risks that participation at Yamaji Dojo Martial Arts & Fitness 693232NB Inc carries with it inherent risks related to COVID-19 transmission (“Inherent Risks”) that cannot be eliminated regardless of the care taken to avoid such risks. Inherent Risks may include, but are not limited to, (1) the risk of coming into close contact with individuals or objects that may be carrying COVID-19; (2) the risk of transmitting or contracting COVID-19, directly or indirectly, to or from other individuals; and (3) injuries and complications ranging in severity from minor to catastrophic, including death, resulting directly or indirectly fromCOVID-19 or the treatment thereof.

Further, I understand and accept that the risks ofCOVID-19 are not fully understood, and that contact with, or transmission of,COVID-19 may result in risks including but not limited to loss, personal injury, sickness, death, damage, and expense, the exact nature of which are not currently ascertainable, and all of which are to be considered Inherent Risks.

I hereby voluntarily accept and assume all risk of loss, personal injury, sickness, death, damage, and expense arising from such Inherent Risks. Furthermore, I represent and warrant that I do not suffer from any medical condition or disease that might in any way hinder or prevent me from receiving the Services, including, to my knowledge, COVID-19. I hereby agree to contact Yamaji Dojo Martial Arts & Fitness 693232NB Inc immediately for any of the following (1) I contract COVID-19; (2) I was in contact with anyone that contracted COVID-19); I experience any of the following Flu Symptoms, Sore Throat, Vomiting, Cough, Tiredness and Fever.

Signature Here Please

Electronic Signature Consent *

By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.