Vancouver West Aikikai Membership Form
Name:____________________________________________________________
Birth Date: (Month Day Year)

Address:_________________________________________________________

Home Phone:______________________________________________________________________________________

Other Phone:email address:_________________________________________________________

Emergency Contact Name:

Emergency Contact Phone:_________________________________________________________

Doctor’s Name:

Doctor’s Phone:_________________________________________________________

Current Rank: _________________

Date Received: ________________

Aikido Start Date:_______________ Current Date:__________________
Previous Dojo(s) and Sensei(s):__________________________________________________________________________________________________________________________________________________________
Describe any physical or medical condition (including medications) that
could affect your ability to practise Aikido:____________________________________________________________________________________________________________________________________________________________________________________

Vancouver West Aikikai

WAIVER AND RELEASE OF LIABILITY
By signing this form you give up important legal rights. Please read carefully!
This is a binding legal agreement. As a Participant in the programs, activities and events of Vancouver West Aikikai, the undersigned
acknowledges and agrees to the following terms.
Disclaimer: Vancouver West Aikikai and/or the Canadian Aikido Federation, its directors, officers, members, employees,
independent contractors, instructors, coaches, volunteers, officials, participants, clubs, agents, sponsors, funding partners,
owners/operators of the facility, and representatives (the “Organization”) are not responsible for any injury, damage or loss of any kindsuffered by a Participant during, or as a result of, any program, activity or event, caused in any manner whatsoever including, but notlimited to, the negligence of the Organization.
Description of Risks: In consideration of my participation in such programs, activities and events, I hereby acknowledge that I amaware of the risks and hazards associated with or related to the sport of Aikido and that they may result in personal injury, death,property damage, expense and related loss to me. I understand that Aikido training is practiced without protective clothing or equipment
and involves many inherent physical risks. These include, but are not limited to, injuries resulting from:• Transmission of communicable diseases, including• Tumbling, falling or being thrown to the floor
viruses of all kinds, COVID-19, bacteria, and parasites• Ongoing physical contact with the instructor and other• Exerting and stretching various muscle groups
students• Striking objects with parts of the body
• Executing self-defence escapes and techniques• Executing strenuous and demanding physical techniques• Dehydration, strenuous cardiovascular workouts, andextreme changes in temperature• Collisions with the wall, floor, other students and• Travel to and from competitive events and associatedinstructors
non-competitive events which are an integral part of theOrganization’s activities
COVID-19: While the Organization has put in place preventive measures to reduce the spread of COVID-19, the Organization
cannot guarantee that I will not become infected with COVID-19. Further, participating in the Activities could increase my riskof contracting COVID-19.
Initials: _________
Furthermore, I am aware:• That injuries sustained in Aikido can be severe;• That I may come into close contact with other participants, including the possibility of accidental and unexpected touching;• That I may experience anxiety while challenging myself during the activities;• That my risk of injury is reduced if I follow all rules adopted during training and competition;• That my risk of injury increases as I become fatigued; and• (COVID-19) That COVID-19 is contagious in nature and I may be exposed to, or infected by, COVID-19 and such exposure
may result in personal injury, illness, permanent disability, or death.
Release of Liability: In consideration of the Organization allowing me to participate, I agree:a) To assume all risks arising out of, associated with or related to my participation;b) To be solely responsible for any injury, loss or damage that I might sustain while participating; andc) To release the Organization from liability for any and all claims, demands, actions and costs that might arise out of myparticipating, even though such risks, injuries, loss, damage, claims, demands, actions or costs may have been caused by thenegligence of the Organization.
Acknowledgement: I acknowledge that I am physically fit to proceed with this type of vigorous training, that I have read thisagreement, that I have executed this agreement voluntarily, and that this agreement is to be binding upon myself, my heirs, executors,administrators and representatives.
Vancouver West Aikikai Code of Conduct: I further acknowledge that I have read the Vancouver West Aikikai Code of Conduct
and that I am aware, accept and will abide by the major principles, among which are: I will adhere to the given instructions and will
not not engage in a self-serving practice in class. I will avoid doing ara-waza (vigorous or rough techniques), kaeshi-waza (countertechniques), henka-waza (modified or unexpected techniques), or renraku-waza (combination techniques), unless instructed to do so. I
will avoid unproductive resistance or competition with others, avoid using unnecessary force or displaying competitive or aggressive
attitude and I will make every effort to prevent injuries.
Initials: _____________________________________________Name of Participant_____________________
Date____________________________________
Signature of Participant____________________________
Witness