Agreement of Release and Waiver of Liability

Organization: Hilltop Dojo

Location: 3025 Research Drive / 3025 Hilltop Mall Road, Richmond, CA 94806

Activities: Karate (Uechi Ryu, Shotokan), Qi Gong, Fitness Training, and Sparring.

1. Voluntary Participation: I, ___________________________ (Participant Name), acknowledge that I have voluntarily applied to participate in martial arts training and fitness programs at Hilltop Dojo. If the participant is a minor, I, as the parent or legal guardian, give my consent for their participation.

2. Assumption of Risk: I am aware that martial arts training (including karate and sparring) and fitness activities are physically demanding and involve inherent risks of injury, including but not limited to: bruises, scrapes, muscle strains, broken bones, or more serious injuries. I voluntarily assume all risks associated with my participation (or my child’s participation).

3. Health Representation: I represent that I (or my child) am in good physical health and do not suffer from any condition that would limit participation in these programs. I understand it is my responsibility to consult with a physician prior to beginning any new fitness or martial arts regimen.

4. Release of Liability: In consideration of being permitted to participate in the classes and activities offered by Hilltop Dojo, I hereby waive, release, and forever discharge Hilltop Dojo, its instructors (including Sensei Mehran Shakhar), staff, and the property owners from any and all claims, demands, or causes of action for personal injury, property damage, or wrongful death arising out of my participation in training, whether caused by negligence or otherwise.

5. COVID-19 & Communicable Diseases: I acknowledge the contagious nature of COVID-19 and other communicable diseases and voluntarily assume the risk that I may be exposed to or infected by such diseases by attending the Dojo.

6. Medical Treatment: I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during the activities.

I HAVE READ THIS RELEASE OF LIABILITY AND FULLY UNDERSTAND ITS TERMS. I UNDERSTAND THAT I AM GIVING UP SUBSTANTIAL RIGHTS BY SIGNING IT.

Participant Signature: _________________________________ Date: ___________

(If under 18, Parent/Guardian signature required)

Print Name: _________________________________________