Karate Program Registration


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Cape Fear Isshin-Ryu After School Karate Program REGISTRATION FORM


  • Student



  • In case of emergency, contact:


  • I understand that karate and all other Martial Arts are sports involving physical contact and physical exercise. I am aware that my child is engaging in physical exercise and self-defense instruction. I understand that it is advisable to contact my child’s physician before entering any physical fitness program. My child is voluntarily participating in these activities. In the event I cannot be reached in an emergency, I hereby give my consent to Cape Fear Isshin-Ryu, its instructors, employees, or any Emergency Medical Personnel to administer or secure any necessary treatment to my child in the event of an emergency and transport him/her by ambulance if the situation warrants.

Cape Fear Isshin-Ryu Waiver Agreement

Release of Liability

I hereby waive and release any claim or rights to sue Cape Fear Isshin-Ryu, it’s agents, officers, students, instructors, employees, volunteers and management from any and all injuries that may occur on or off these premises through negligence or not, while participating, practicing, watching or competing in Karate or any other event or program. Students and their guests in using the dojo and any equipment, do so at their own risk. Cape Fear Isshin-Ryu, its agents, officers, students, instructors, employees, volunteers and management shall not be liable for any damages arising from personal injuries sustained by students and their guests, in, on, or about the premises of the dojo. The dojo assumes no responsibility for loss of, or damage to, any personal property belonging to student or guest while on the premises.

I understand that while in regular Karate or any events or programs, my child may be engaging in activities (karate, martial arts training, dodge ball, etc. ) and that these activates may have risks and hazards inherent to the type of activity or use of certain equipment or the facilities themselves. As we are aware, young children are prone to mishaps. Although we will give every effort to have adequate supervision, occasionally accidents will happen. In the instance that an emergency arises we would use this form as your specific permission to transport and have your child treated by a professional caregiver/physician, etc.

In signing this consent form, I hereby acknowledge and represent that I have read the foregoing, understand its terms, and sign it voluntarily. I also acknowledge that my child/children is in excellent physical health and is able to endure strenuous recreational activates and play, including the above named activities and others not mentioned or stated. Students represent that he or she is in good physical condition and able to use the equipment provided and to participate in program made available by the dojo. The dojo represents that its personnel are trained in providing equipment and instruction.

I have read and agree with all the above. I agree to waive any and all claims against persons connected with Cape Fear Isshin-Ryu.



Release and Waiver of Liability and Indemnity Agreement

(Read Carefully Before Signing)

In consideration of being permitted to participate in any way in the Martial Arts Program indicated below and/or being permitted to enter for any purpose any restricted area (here in defined as any area where in admittance to the general public is prohibited), the parent(s) and/or legal guardian(s) of the minor participant named below agree:

  1. The parent(s) and/or legal guardian(s) will instruct the minor participant that prior to participating in the below martial arts activity or event, he or she should inspect the facilities and equipment to be used, and if he or she believes anything is unsafe, the participant should immediately advise the officials of such condition and refuse to participate. I understand and agree that, if at any time, I feel anything to be UNSAFE; I will immediately take all precautions to avoid the unsafe area and REFUSE TO PARTICIPATE further.
  2. I/We fully understand and acknowledge that:
    a. There are risks and dangers associated with participation in martial arts events and activities which could result in bodily injury partial and/or total disability, paralysis and death.
    b. The social and economic losses and/or damages, which could result from these risks and dangers described above, could be severe.
    c. These risks and dangers may be caused by the action, inaction or negligence of the participant or the action, inaction or negligence of others, including, but not limited to, the Releasees named below.
    d. There may be other risks not known to us or are not reasonably foreseeable at this time.
  3. I/WE accept and assume such risks and responsibility for the losses and/or damages following such injury, disability, paralysis or death, however caused and whether caused in whole or in part by the negligence of the Releasees named below.
  4. I/We HEREBY RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE the martial arts facility used by the participant, including it owners, managers, promoters, lessees of premises used to conduct the martial arts event or program, premises and event inspectors, underwriters, consultants and others who give recommendations, directions or instructions to engage in risk evaluation or loss control activities regarding the martial arts facility or events held at such facility and each of them, their directors, officers, agents, employees, all for the purpose herein referred to as “Releasee”…From all liability to the undersigned, my/our personal representatives, assigns, executors, heirs and next to kin For any and all claims, demands, losses or damages and any claims or demands therefore on account of any injury, including but not limited to the death of the participant or damage to property, arising out of or relating to the events(s) caused alleged to be caused in whole or in part by the negligence of the releasee or otherwise.
  5. I/We HEREBY acknowledge that THE ACTIVITIES OF THE EVENT(S) ARE VERY DANGEROUS and involve the risk of serious injury and/or death and/or property damage. Each of THE UNDERSIGNED also expressly acknowledges that INJURIES RECEIVED MAY BE COMPOUNDED OR INCREASED BY NEGLIGENT RESCUE OPERATIONS OR PROCEDURES OF THE RELEASEES.
  6. EACH OF THE UNDERSIGNED further expressly agrees that the foregoing release, waiver, and indemnity agreement is intended to be as broad and inclusive as is permitted by the law of the Province or State in which the event is conducted and that if any portion is held invalid, it is agreed that the balance shall, notwithstanding continue in full legal force and effect.
  7. On behalf of the participant and individually, the undersigned partners(s) and/or legal guardian(s) for the minor participant executes this Waiver and Release. If, despite the release, the participant makes a claim against any of the Releasees, the parents(s) and/or legal guardian(s) will reimburse the Releasee for any money which they have paid to the participant, or on his behalf, and hold them harmless.

I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WTHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.


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