CYO Form

Name *

First Name

Last Name

Phone

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WAIVER *

Assumption of Risk. Participant expressly understands and agrees that participant in Non-Varsity Athletic Activities presents risks to Participant both serious and minor, including but not limited to head or other injuries, loss of sight, broken bones, brain damage, paralysis and death. Participant is responsible for researching and evaluating the risks she/he may face and is responsible for her/his actions. Participant further recognizes, understands and agrees that the City Aikido assumes no responsibility for any liability, damage or injury that may be caused by Participant’s negligence or willful acts committed prior to, during or after participation in the Activity, or for any liability, damage or injury caused by the intentional or negligent acts or omissions of any other participant in the Activity, or caused by any other person. Indemnification and Hold Harmless. Participant specifically understands that she/he is personally responsible, agrees to indemnify, defend and holds harmless City Aikido, their officers, agents, volunteers, students and employees from any action, claim, or demand that his/her heirs, or legal representatives, have or may have for any and all personal injuries he/she may suffer or sustain, regardless of cause or fault as a result of his/her voluntary decision to participate in the Activity or related activities, in or out of the dojo including reasonable attorneys' fees and/or any other associated costs, caused by any act or omission of Participant resulting from direct or indirect participation in the Activity.

I have read above information.

I agree to the terms of the waiver: *

First Name

Last Name

Date *

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