Guest Registration & Permission
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Email *
Party Date? *
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Party Time? *
Party Host Parent? *
The Age of Your Child *
Child Name   *
Authentic Martial Arts Member *
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Your Child's Birth Day Month *
Your Relationship with the Birthday Child or Guest *
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Your Phone Number *
I Have Permission to Provide Consent for the Above Named Guest to Participate in the AMA Birthday Party *
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Waiver and Unconditional Full Release
I have voluntarily elected to allow the minor child identified above referred to individually and collectively herein as the “Child,” to use the Authentic Martial Arts (AMA) Facilities and equipment (including but not limited to the rock climbing wall, bounce house, and the ninja gym obstacle course located at the Seminole facility) located at the following two (2) locations: 1) 7633 131st Street N, Seminole, FL 33776; and 2) 780 Missouri Ave N, Largo, FL 33770 (hereinafter referred to as the “AMA Facilities”). In consideration for being allowed to use said facilities and equipment, and any other services provided by AMA or its employees or agents at said locations,  I represent, acknowledge and agree as follows:
I acknowledge and agree that this Agreement covers and is intended to release and provide other benefits, legal protections, and consideration to the AMA After School Enrichment Program, Authentic Martial Arts, Inc., Authentic Martial Arts-Seminole, LLC, Karate Karma, LLC, JC23 Holdings LLC, and AMA-Plus-Seminole LLC, and their respective and collective agents, owners, officers, managers, shareholders, affiliates, volunteers, participants, employees, and all other persons or entities acting in any capacity on their respective or collective behalf (collectively referred to as “Releasees” or “AMA”).
RELEASE OF POTENTIAL INJURIES
I acknowledge and agree that the use of equipment at the AMA Facilities (or the use of facilities or equipment while at any AMA field trips) and participating in activities including but not limited to martial arts, karate, stretching, parkour, gymnastics, tumbling, use of the ninja gym obstacle course, the rock climbing wall, bounce bouse, outdoor sports and other activities, or any other physical activities is inherently and obviously dangerous. These risks include serious physical or emotional injury, paralysis, death, damage to the Child and/or third parties, and damage to personal property of any or all such persons. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity, which I further agree is for recreational purposes and completely voluntary.
VOLUNTARY ASSUMPTION OF RISK
I acknowledge and agree that the Child is participating voluntarily at our own risk. I, the parent or legal guardian, am aware that the Child is engaging in physical exercise, sports related activities, and self-defense instruction, martial arts, karate, stretching, parkour, gymnastics, tumbling, use of the ninja gym obstacle course, bounce house, the rock climbing wall, outdoor sports and other activities, or any other physical activities is inherently and obviously dangerous. I, the parent or legal guardian, acknowledge that some of the risks of these activities include, but are not limited to, death or paralysis. In addition, the Child may sprain, pull, break or otherwise seriously externally or internally injure their head, face (including nose and teeth/jaw), neck, torso, spine, arms, wrists, hands, legs, ankles, feet or other body parts as a result of falling on equipment, landing improperly on equipment, or making contact with other participants. As noted above, such injuries can lead to paralysis, disfigurement or death. I understand that the Child’s participation may result in heat stroke, heart attacks, dehydration and other exertion-related medical events.
AGREEMENT TO PAY MEDICAL EXPENSES
I acknowledge, accept, and assume the risk of any and all medical conditions, limitations, or disabilities (whether temporary or permanent) that the Child possesses, whether known or unknown, which might contribute to or exacerbate any injury the Child might sustain as a result of using the AMA Facilities or any of its equipment including but not limited to the ninja gym obstacle course, bounce house, or rock climbing wall (or using the facilities and equipment during any AMA field trips). I acknowledge and agree that if medical assistance (of any form, including emergency care, hospitalization, out-patient care, and/or physical therapy) is required or performed as a result of any injury the Child sustains while using the AMA Facilities (or while using the facilities or equipment at any AMA field trips), such assistance shall be at my own expense.
RELEASE OF LIABILITY
I, the parent or legal guardian, irrevocably and unconditionally release, waive, relinquish, discharge from liability and covenant not to sue AMA and their related entities, successors, owners, parent companies, employees, agents, instructors, consultants, volunteers, management entities, affiliated holding companies, landlords, predecessors-in-interest, and insurers (collectively, “AMA”) from any and all claims, demands, rights, actions, suits, causes of action, obligations, debts, costs, losses, charges, expenses, attorneys’ fees, damages, judgments and liabilities, of whatever kind or nature, in law, equity or otherwise, whether now known or unknown, suspected or unsuspected, and whether or not concealed or hidden, related to or arising, directly or indirectly, from the Child’s access to and/or use of the AMA Facilities, premises and/or its equipment (including but not limited to the rock climbing wall, bounce house, and the ninja gym obstacle course), the Child’s entry into the AMA Facilities, the condition, maintenance, inspection, supervision, control or security of the AMA Facilities, the failure to warn of dangerous conditions in connection with the AMA Facilities, and/or the acts or omissions of AMA or any of the Releasees, including, without limitation, any claim for negligence, failure to warn or other omission, property damage, personal injury, emotional injury, illness, bodily harm, paralysis or death. I understand that this release and waiver applies to all equipment, and all activities and games at the AMA Facilities including but not limited to the rock climbing wall, bounce house, and the ninja gym obstacle course. I understand that this release and waiver applies to and includes all activities that my Child may engage in at the premises, whether inside or outside the AMA Facilities.
ARBITRATION OF DISPUTES
Arbitration is a method of resolving disputes without involving the courts. In an arbitration proceeding, the dispute is heard by a private individual, called an arbitrator, who is selected by the parties. The decision of the arbitrator binds both parties and is final. By agreeing to binding arbitration, both parties waive the right to a trial before a judge or jury. By signing this Agreement, I hereby agree to arbitrate any dispute arising out of this Agreement. By agreeing to arbitrate, I understand that I am waiving my right, and the right(s) of the minor Child, to maintain a lawsuit against AMA for any and all claims covered by this Agreement. By agreeing to arbitrate, I understand that I will NOT have the right to have my claim determined by a jury, and the minor Child will NOT have the right to have claim(s) determined by a jury. Reciprocally, AMA waives its right to maintain a lawsuit against me and the minor Child for any and all claims covered by this Agreement, and will not have the right to have their claim(s) determined by a jury. The parties agree that the arbitration panel shall be composed of one (1) arbitrator. The arbitrator shall be chosen by the parties. If the parties cannot agree to a choice of an arbitrator, the arbitrator shall be chosen as set forth in the Florida Arbitration Code. Both parties have the right to be represented by an attorney at the arbitration at their own expense. Each party is to bear their own attorneys’ fees and costs incurred in relation to any arbitration conducted pursuant to this Agreement. All costs and expenses of the arbitrator shall be borne equally by the parties. This Agreement shall be governed by, construed and interpreted in accordance with the laws of the State of Florida. Notwithstanding the provision with respect to the applicable substantive law, any arbitration conducted pursuant to the terms of this Agreement shall be governed by the Florida Arbitration Code and the Federal Arbitration Act. If any sentence, word, phrase, paragraph or portion of this Agreement should at any time be held invalid or unenforceable for any reason, that holding will not affect in any way the meaning of the other sentences, words, phrases, paragraphs or portions of this Agreement, and all remaining portions shall remain in full force and effect as if the portion that was held invalid was not originally a part of this Agreement.
PHOTO/VIDEO/SOCIAL MEDIA WAIVER
In connection with the Child’s use of the AMA Facilities, I consent to the recording of the Child’s physical likeness and/or voice through mechanical, photographic, technical, digital, electronic or other means (“Recordings”). I hereby consent to and authorize AMA and its agents, representatives, employees, successors and assigns to use, in perpetuity, such Recordings, as well as the Child’s name, for any purpose, including advertising, promoting, and/or publicizing the AMA Facilities. I further agree that the foregoing includes the consent to use the Child’s physical likeness in any form. In addition, I waive any and all claims I may have in connection with the Recordings.

NOTICE TO THE MINOR CHILD’S PARENT OR NATURAL OR LEGAL GUARDIAN:
READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO LET YOUR MINOR CHILD ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY. YOU ARE AGREEING THAT, EVEN IF AMA AND ALL OTHER RELEASEES USE REASONABLE CARE IN PROVIDING THIS ACTIVITY, THERE IS A CHANCE YOUR CHILD MAY BE SERIOUSLY INJURED OR KILLED BY PARTICIPATING IN THIS ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM YOU ARE GIVING UP YOUR CHILD’S RIGHT AND YOUR RIGHT TO RECOVER FROM AMA AND ALL OTHER RELEASEES IN A LAWSUIT FOR ANY PERSONAL INJURY, INCLUDING DEATH, TO YOUR CHILD OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A NATURAL PART OF THE ACTIVITY. YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM, AND AMA AND ALL OTHER RELEASEES HAVE THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN THIS FORM.

I agree that I have read and understood the preceding paragraph.  I have had sufficient opportunity to read this document. I have read and understood and agree to be bound by its terms. I understand that employees working at the AMA Facilities do not have the authority to waive any provision of this Agreement. This Agreement constitutes and contains the entire agreement between AMA and me relating to the Child’s use of the AMA Facilities. There are no other agreements, oral, written, or implied, with respect to such matters. I further agree that this Release shall be construed in accordance with the laws of the State of Florida.  If any term or provision of this Release shall be held illegal, unenforceable, or in conflict with any law governing this Release the validity of the remaining portions shall not be affected thereby. By signing below, I represent and warrant that I am the parent, legal guardian, natural guardian or power-of-attorney of the above listed Child and have the authority to execute this Agreement on his/her or their behalf and to act on his/her or their behalf. I have read each and every paragraph in this document and I and they agree to be bound by the terms stated therein, including the release of liability contained therein. I further agree to indemnify and hold harmless AMA from any and all claims which are brought by or on behalf of this minor Child, which are in any way connected with, arise out of, or result from their use of the AMA Facilities.  I am 18 years of age or older. I am entering this agreement on behalf of the Child, and our respective and/or collective issue, parents, siblings, heirs, assigns, personal representatives, estate(s), and anyone else who can claim by or through such person or persons.
 
IN SUMMARY, BY MY SIGNATURE BELOW, I ACKNOWLEDGE THAT IF MY CHILD IS INJURED IN ANY WAY, THIS WAIVER PREVENTS AND PROHIBITS ANY RECOVERY OF MONEY FROM AMA AND THE LIST OF RELEASEES AS SET FORTH ABOVE.
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I am providing consent for the above named child or children. I certify that I am the parent or legal guardian. *
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