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Genbu-Kai Karate

SHITO-RYU KARATE-DO GENBU-KAI OF MICHIGAN

Specializing in the art of Shito-Ryu Karate-Do, Self Defense, Okinawan Kobudo and Batto-Do


Genbu-Kai of Clinton Twp. LLC.  LIABILITY RELEASE

The undersigned and, in the event the undersigned is under 18 years of age, the undersigned’s parent(s) or guardian(s), for and consideration of the granting of membership in the Genbu-Kai of Clinton Twp. LLC, hereby hold(s) harmless and indemnify(ies) the federation, the officers and employees thereof, instructors and other members and students, either individually or jointly, from and against any and all claims and demands whatsoever, including but not limited to those arising from any accidents, illness, injury to or death of any person or persons, resulting directly or indirectly from participation in training or any other activity related to this membership in the federation or club and occurring during said participation or anytime subsequent thereto.  Further, the undesigned understand(s) there is a certain element of danger and injury.  It is also understood that the Federation or club reserves the right to void this membership for any action deemed undesirable.  The undersigned stipulates that he or she is physically sound and has medical approval to proceed with the normal routine exercise. Limitations, if any are noted on the provided medical form.

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Student _________________________ DOB:___/___/____

          

Student _________________________     DOB:___/___/____                                                                 

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Student _________________________     DOB:___/___/____       


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Parent / Guardian Signature (Under 18 Years Old)


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Student Signature (Over 18 Years Old)