LIABILITY WAIVER
I hereby submit my child or my application for registration at Rodriguez Karate
Academy. I hereby agree that reasonable care is taken to prevent serious injuries
and to minimize accidents and understand the requirements that students must
obey the rules and regulations of said instruction. Recognizing that physical injuries
is an inherent risk in the practice of Tang Soo Do at Rodriguez Karate Academy. I
understand that my child or I am participating in a physical contact program which
has body contact, rolling, jumping and throwing techniques. I agree to hold Carlos
and Misty Rodriguez’s Rodriguez Karate Academy, any and all instructors, students,
participants free and harmless of any liability for damages, or physical injury arising
from my child or my participation at Rodriguez Karate Academy. Including: karate
classes, demonstrations, tournament competitions, falling or being struck by a
fellow practitioner. I further agree that I am fully responsible for all medical
expenses that may incur.
I Hereby agree that any pictures and/or videos taken of the enrolled member in connection
with Carlos and Misty Rodriguez’s Rodriguez Karate Academy may be used by Carlos or
Misty Rodriguez for publicity and/or promotional advertisement for Rodriguez Karate
Academy without compensation currently or at any future date.
By signing this agreement, I acknowledge the contagious nature of Covid-19 and
voluntarily assume the risk and sole responsibility that the enrolled member and other
family members may be exposed to or infected by Covid-19 by attending and/or
participating in karate lessons at Rodriguez Karate Academy. I understand that the
attendance of the enrolled member is completely voluntary, and the enrolled or other
family members may be exposed or infected which could result in personal injury,
permanent disability, and/or death.
Student information:
First Name:
Last Name:
Sign below: If enrollee is a minor then parent or legal guardian please sign.