WaiverPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Before arriving for your first class at the dojo, please fill out this waiver form. You will need to fill out one for each individual, minor, or family member.Participant InformationParticipant Name *Participant/Guardian Email *Guardian Name (if Participant is younger than 18)Date of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Phone *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmergency Contact InformationPlease fill out information for at least one emergency contact.Emergency Contact Name 1 *Emergency Contact Name 2Emergency Contact Phone 1 *Emergency Contact Phone 2Release of Liability *I agree to the following:North Boulder Budo, LLCParticipant Agreement, Waiver, Release, and Assumption of RiskWe are excited that you have expressed interest in North Boulder Budo, LLC (“NBB”). Because of the nature of the physical exercises and martial arts performed at NBB, this Participant Agreement, Waiver, Release, and Assumption of Risk (“Agreement”) is required as a condition of your participation at NBB.In consideration of the services of NBB, their agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as “NBB”), I hereby agree to release, indemnify, and discharge NBB, on behalf of myself, my children, my parents, my heirs, assigns, personal representative and estate as follows:I understand that participation in physical exercises and martial arts carries with it certain inherent dangers and risks. I have knowingly and voluntarily chosen to engage in such activity with full knowledge and understanding of the potential dangers and risks and accept such risks, including, by way of example, but not limitation: the dangers of working with weapons; the dangers arising from hand to hand combat; the dangers associated with inadequate training and equipment failure, and inadequate safety equipment. I understand that I have the opportunity to inspect all tools, weapons, and related equipment and space prior to training for or participating in physical exercises and martial arts training at NBB and I assume the risk of all conditions. I understand that no information or advice I receive from NBB is intended to be legal or medical advice. In the event that I have legal or medical questions, I will consult an attorney or medical professional. I acknowledge that my participation in “activities” at NBB which include indoor/outdoor physical fitness activities and martial arts training and entails known, unknown and unanticipated risks that could result in physical injury, paralysis, death, or damage to myself, to property, or to third parties. I understand that such risks simply cannot be eliminated. NBB employees have difficult jobs to perform. They strive to keep participants safe, but they may be unaware of a participant’s fitness or abilities. They may give inadequate warnings or instructions, and the equipment being used may malfunction. I expressly agree to inform NBB on Attachment A, “Preexisting Conditions” of this Agreement of any physical, emotional, mental or fitness related conditions I experience, or have experienced in the past. Potential risks include, but are not limited to: slipping and falling; falling objects; exhaustion; dehydration; confrontation among participants; splinters, bruises; twisted, pulled, strained and sprained muscles; broken bones, joint injuries, punctures, lacerations, contusions, abrasions; cardiac and respiratory problems due to physical stress and/or exertion; and trauma. I acknowledge that I have assessed my own emotional, mental, and physical wellbeing, and I have concluded that I wish to and am able to participate in activities at NBB. I agree to disclose on Attachment A, “Preexisting Conditions” of this Agreement, any psychological or physical health problems or limitations at the time of application and in any event prior to the class commencing. Upon entering NBB, I expressly agree to participate at my own risk regardless of any disclosures or written approvals and continue to bear sole responsibility for my own safety. I agree to indemnify and hold harmless NBB, its officers, directors, affiliates, successors, assigns, insurers, principals, agents, contractors, representatives, employees and attorneys, from any and all liability for any and all claims resulting from or in any way arising or growing out of, and by reason of any and all known and unknown, foreseen and unforeseen claims, and the consequences thereof, regarding any liability arising out of my dealings with NBB, including, without limitation, any actions brought against NBB regarding personal injury, property damage, or other loss resulting from my participation in activities with NBB or exercise, equipment, or any method engaged in on the premises including any such claims which allege negligent acts or omissions of NBB. I further certify that I knowingly and voluntarily assume the risk of injury and/or damage caused from any medical or physical condition I have, whether known or unknown. I undertake the use of NBB methods, activities and training at my own risk. I HEREBY EXEMPT AND RELEASE NBB, ITS EMPLOYEES, AGENTS,ASSIGNS, SERVANTS , SPONSORS, ORGANIZERS AND PROMOTING ORGANIZATIONS, PROPERTY OWNERS, AND LAW ENFORCEMENT AGENCIES THAT ARE IN ANY WAY CONNECTED WITH THIS EVENT AND THEIR RESPECTIVE AGENTS OFFICIALS, EMPLOYEES AND ASSIGNS (COLLECTIVELY REFERRED TO AS RELEASEES”) FROM ANY AND ALL LIABILITY, CLAIMS, DEMANDS, OR ACTIONS, OR CAUSES OF ACTION WHATSOEVER ARISING OUT OF ANY DAMAGE, LOSS OR BODILY INJURY OR DEATH TO MYSELF OR DAMAGES TO MY PROPERTY WHILE ENGAGED IN THE ACTIVITIES CONTEMPLATED BY THIS RELEASE AND INDEMNIFICATION WHETHER SUCH LOSS, DAMAGE OR INJURY RESULTS FROM THE NEGLIGENCE OF NBB AND RELEASEES OR FROM ANY OTHER CAUSE WHATSOEVER. I ACKNOWLEDGE AND UNDERSTAND THAT I, MY HEIRS, SUCCESSORS, AGENTS, PERSONAL REPRESENTATIVES AND ASSIGNS SHALL NOT HAVE THE RIGHT TO SUE OR LOOK TO NBB AND THE RELEASEES FOR RECOVERY OF ANY DAMAGE OR LOSS WHATSOEVER WHICH I MAY SUFFER AS A RESULT OF THE ACTIVITIES CONTEMPLATED IN THIS RELEASE AND INDEMNIFICATION. TO THE FULLEST EXTENT PERMITTED BY LAW, I HEREBY AGREE TO PROTECT, DEFEND, INDEMNIFY AND HOLD NBB, ITS EMPLOYEES, AGENTS,ASSIGNS, SERVANTS, SPONSORS, ORGANIZERS AND PROMOTING ORGANIZATIONS, PROPERTY OWNERS, AND LAW ENFORCEMENT AGENCIES THAT ARE IN ANY WAY CONNECTED WITH THIS EVENT AND THEIR RESPECTIVE AGENTS OFFICIALS, EMPLOYEES AND ASSIGNS, THE RELEASEES, HARMLESS AND FREE FROM AND AGAINST ANY AND ALL CLAIMS, DEMANDS, CAUSES OF ACTION, SUITS OR LITIGATION OF EVERY KIND AND CHARACTER, INCLUDING THE COST THEREOF AND ATTORNEYS’ FEES, ASSERTED BY ANY THIRD PARTY ON ACCOUNT OF BODILY OR PERSONAL INJURY, DEATH OR DAMAGE TO OR LOSS OF PROPERTY IN ANY WAY OCCURRING INCIDENT TO, ARISING OUT OF OR IN CONNECTION WITH ANY ACT OF MYSELF WHILE ENGAGED IN THE ACTIVITIES CONTEMPLATED IN THIS AGREEMENT. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating in activities with NBB, and I agree to personally bear any and all costs of injury or damage sustained during my participation with NBB. I agree to maintain the confidential nature of all activities, techniques and training obtained during my participation at NBB. I agree not to disclose any techniques obtained while participating at NBB. I understand that I am free to share my own experiences gained through NBB, so long as I do not disclose information about confidential activities, technique and training. In the event of any dispute between me and NBB regarding this Agreement that we are unable to resolve among ourselves, we shall first submit the dispute to mediation in Boulder, Colorado. We shall select one mediator, who shall not be related to, affiliated with, or employed by either party. If NBB and I cannot first resolve the dispute through mediation, then within sixty (60) days of any failed mediation, we may pursue our claims in a court located in Boulder, Colorado. NBB and I shall be obligated to pay for our respective fees, costs and expenses (including reasonable attorney’s fees) incurred, and shall equally share in the fees of the Mediation. In case of any action or proceeding to compel compliance with, or for a breach of any of the terms and conditions of this Agreement, the prevailing party will be entitled to recover from the non-prevailing party all costs of such action or proceeding, including, without limitation, reasonable attorneys’ fees, accountants’ fees, costs, and disbursements. This Agreement and any dispute or controversy arising from this Agreement will be construed in accordance with and governed by the laws of the State of Colorado. If you have any questions regarding this Agreement, please contact a member of the NBB staff to fully discuss your questions and/or concerns. By signing this Agreement, I acknowledge that if anyone is hurt or property is damaged during my participation in activities with NBB, I may be found by a court of law to have waived my right to maintain a lawsuit against NBB on the basis of any claim from which they are hereby released. I authorize NBB to record and edit into its Video/Photograph and related materials my name, likeness, image, voice, interview, and performance. NBB may use and authorize others to use all or parts of the Video or Photograph. NBB shall own all right, title, and interest in and to the Video or Photograph, including the recordings, to be used and disposed of without limitation as the Person Filming shall in his or her sole discretion determine. I have had sufficient time and opportunity to read the entire Agreement. I expressly represent that I have read and understand the entire Agreement, and I agree to be bound by all of the Agreement’s terms.Signature * Clear SignatureSign Waiver