STUDENT AGREEMENT AND RELEASE FORMS

Please read the following carefully:

Students' Basic Responsibilities

1. Membership in Aikido Kenkyukai entitles one to practice and receive the full benefits of aikido training.

2. Monthly dues and the annual membership fee secure one’s membership in the dojo. We are not a business. Dues must be paid by the tenth of each month. Monthly dues are $65. Dues are paid even if one is unable to train for a particular month. This is a symbol of our ongoing commitment to the dojo and to our training.. The monthly dues are placed in the dojo account and are used to pay the rent and sometimes help defray the costs of special activities including visits from the senior instructors from Japan. There is an annual membership fee is $50 which is sent directly to Takeda Shihan and our sponsoring dojo in Japan as a mere token of respect and gratitude for their continued support of us.

3. Testing fees are to be paid directly to Sensei. 5th and 4th kyu tests are $30. 3rd, 2nd, and 1st kyu tests are $45. These should be paid directly to Lia Suzuki Sensei as soon as possible following testing.

4. There is an $10 mat fee for visitors who are active members in another dojo.

5. If a student is absent from the dojo for a month or more without giving notice of the intent to take a leave of absence, they are responsible for the dues of that period.

6. Monthly dues do not cover the costs of special seminars, gasshukus, etc..

7. Dues are not refundable.

8. Training while under the effects of any intoxicating substance, legal or illegal will be cause for immediate dismissal from the dojo.

9. Students are required to wear a gi from no later than the second month of their training. Gi should be kept clean, mended, and should not be left in the dojo.

I have read and agree to the above.

Dated ______________ Signature ______________________________________________

Release From Liability (Initial here:____)

In consideration for being permitted to engage and receive instruction in Aikido, I ______________________, agree as follows:

1. I hereby RELEASE AND DISCHARGE (Initial here:____) Lia Suzuki, Stephen Trinkle, Aikido Kenkyukai USA, Santa Barbara Dojo and North Wales Dojo, Aikido Kenkyukai International, their owners, agents, employees and instructors (collectively referred to as “Released Parties”), from any and all liability, claims, demands or causes of action that I may hereafter have for injuries and damages arising out of my participation in Aikido activities, including but not limited to losses CAUSED BY THE NEGLIGENCE OF THE RELEASED PARTIES (Initial here:____).

2. I further agree that I WILL NOT SUE OR MAKE A CLAIM against the Released Parties for damages or other losses sustained as a result of my participation in aikido (Initial here:____). I also agree to INDEMNIFY AND HOLD THE RELEASED

PARTIES HARMLESS from all claims, judgments and costs, including attorneys’ fees, incurred in connection with any action brought as a result of my participation in Aikido (Initial here:____).

3. I understand and acknowledge that Aikido has inherent dangers that no amount of care, caution, instruction or expertise can eliminate and EXPRESSLY AND VOLUNTARILY ASSUME ALL RISK OF PERSONAL INJURY OR DEATH SUSTAINED WHILE PARTICIPATING IN AIKIDO WHETHER OR NOT CAUSED BY THE NEGLIGENCE OF THE RELEASED PARTIES (Initial here:____).

4. I hereby expressly recognize that this Agreement and Release of Liability is a contract pursuant to which I have released any and all claims against the Released Parties resulting from my participation in Aikido including and and all claims caused by the negligence of the Released Parties

(Initial here:____).

5. I expressly agree that this Agreement and Release of Liability is intended to be as broad and inclusive as permitted by the laws of Pennsylvania and that, if any portion of the Agreement is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect (Initial here:____).

6. I hereby release all officials and professional personnel from any claim whatsoever on account of first aid, treatment or service rendered me during participation in Aikido (Initial here:____).

7. I was advised and recognize that instruction in the Aikido involves strenuous exercise and personal body contact with the inherent risk of injury, including, but not limited to, pulled muscles, dislocated joints, and broken bones, that cannot be eliminated (Initial here:____).

8. I was also advised that in accordance with the law, the Released Parties do not exclude individuals with medical conditions that do not pose a medically recognized threat to the health or safety of other students in the normal course of training. I understand that there are some unavoidable circumstances where these conditions may require special caution on my part to minimize danger to others, or myself and I acknowledge that it is my responsibility to act accordingly. (Initial here:____).

9. In particular, I understand that some students may be infected with diseases such as HIV/AIDS and hepatitis that can be transmitted by exchanges of blood or other bodily fluids and that I may be training with them. I acknowledge that I have read and will follow the Released Parties’ procedures (see, below, Blood Borne Pathogen Policy) for dealing with injuries to others, or myself that present opportunities for exposure to blood or body fluids (Initial here:____).

10. I understand that Aikido is an educational system. For the safety of myself and other members, I will practice in a considerate and conscientious manner and strictly follow all rules established by the Released Parties. Should I break any of these rules, I understand that it is the decision of the head instructor whether I may continue training. I will abide by that decision (Initial here:____).

11. This release contains the entire agreement between the parties and the terms are contractual and not a mere recital (Initial here:____).

I HAVE READ THIS AGREEMENT AND SIGN IT OF MY OWN FREE WILL. I FULLY UNDERSTAND ITS CONTENTS AND MEANING AND HEREBY DECLARE MYSEL TO BE PHYSICALLY SOUND WITH MEDICAL APPROVAL TO PARTICIPATE IN AIKIDO.

Dated ______________ Signature ______________________________________________

If the applicant is under 18:

I the undersigned, as parent or guardian of the above applicant, certify that I have read the above agreement and I consent to the applicant’s receiving the instruction applied for and I agree to the provisions of the contract for myself and said applicant.

Dated _____________ Signature_______________________________________________

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