HONOLULUJUDO CLUBBe Strong, Courageous and Gentle

Membership Registration FormToday’s Date: ________________
Member Information:
Name (First, MI, Last)______________________________________________________________________
Date of Birth __________________

Age ________

Sex☐ Male ☐ Female

Address ________________________________________ City _______________ Zip Code ___________
Email Address ___________________________________________ Include in email list? ☐ Yes ☐ NoHome Ph: _____________________ Work Ph: _____________________ Cell Ph: ____________________
Minor’s Father/Guardian _________________________________________________________________
Email Address ___________________________________________ Include in email list? ☐ Yes ☐ NoHome Ph: _____________________ Work Ph: _____________________ Cell Ph: ____________________
Minor’s Mother/Guardian ________________________________________________________________
Email Address ___________________________________________ Include in email list? ☐ Yes ☐ No
Home Ph: _____________________ Work Ph: _____________________ Cell Ph: ____________________
Medical Issues/Physical Limitations:
Medical or physical problems that the instructor should be aware of(i.e. Asthma, epilepsy, heart problems, medication, allergies, or any limiting problems):__________________________________________________________________________________________
Emergency Contact Information (if different from above):
Emergency Contact ______________________________________ Relationship __________________
Home Ph: _____________________ Work Ph: _____________________ Cell Ph: ____________________
Previous Judo Experience:
Dojo/Sensei _________________________________ Current Rank _________ Yrs Experience ______How did you hear about HJC (circle one)?

Internet Member

Other ____________________

Why are you interested in taking judo at HJC? _______________________________________________________________________________________________________________________________________HJC Registration Forms January 2022.docx

HONOLULU
JUDO CLUBBe Strong, Courageous and Gentle

Honolulu Judo Club Waiver and Release of Liability
NAME OF PARTICIPANT_______________________________________ DATE_____________NAME OF PARTICIPANT’S PARENT(S) OR GUARDIAN(S) AUTHORIZED TO SIGN WAIVER FORM FOR
PARTICIPANT: _______________________________________________________
CLUB: HONOLULU JUDO CLUBPARTICIPATORY ACTIVITY: TRAINING SESSIONSIn consideration for 50TH STATE JUDO ASSOCIATION OF HAWAII, the HONOLULU JUDO CLUB, the CEDARASSEMBLIY OF GOD of HONOLULU, and GS INDUSTRIES, acceptance of my entry and for allowing me toparticipate in the Participatory Activity, I do hereby for myself, the Participant, my heirs, executors, and administrators
waive, release, and absolutely and forever discharge the 50TH STATE JUDO ASSOCIATION OF HAWAII, theHONOLULU JUDO CLUB, the CEDAR ASSEMBLIY OF GOD of HONOLULU, GS INDUSTRIES and theirrespective officers, agents, representatives, successors, and assigns from and on account of any and all rights and claims
for injuries of any kind whatsoever up to and including death, obligations, controversies, actions, causes of actions,liability and liabilities, demands, losses and damages (hereinafter collectively “Damages”) which may be sustained andsuffered as a result of any association with and/or entry in the Participatory Activity, including but not limited to any
and all Damages arising out of traveling to, participating, and/or returning from such Participatory Activity.
I further understand and agree that the nature, extent and results of injuries, damages and losses resulting fromparticipation in the Participatory Activity may not be known and anticipated, and the waivers and releases herein coverand are intended to cover all of the injuries, damages and losses resulting from said activities whether or not known oranticipated at this time.
And for the foregoing consideration I hereby covenant and agree to indemnify, defend and forever hold harmless 50TH
STATE JUDO ASSOCIATION OF HAWAII, the HONOLULU JUDO CLUB, the CEDAR ASSEMBLIY OF GOD
of HONOLULU, GS INDUSTRIES and their respective officers, agents, representatives, successors, and assigns
against any and all liability, cost and expense resulting from any claim, demand, suit, action or cause of action (includingclaims of workers’ compensation insurers, temporary disability insurers, medical insurers and no-fault insurers) which
may be asserted by and/or on behalf of any person for injury or damage sustained by myself and/or the Participantarising directly out of the Participating Activities.
IN WITNESS WHEREOF, these presents have been duly executed this ______ day of _______________, ______.

Participant’s Name

Parent/Legal GuardianParticipant’s Signature

Parent/Legal Guardian’s Signature (by signing above, yourepresent that you have the authority to sign for yourself and tobind the Participant to the terms herein).

HJC Registration Forms January 2022.docx

WARNING!
WAIVER AND RELEASE OF LIABILITY AND AGREEMENT TO PARTICIPATE
In consideration of being permitted to participate in any way, including travel to and from, in any Judo tournament, practice, clinic, andrelated events and activities (“Activity”) of the United States Judo Federation, Inc., USA Judo/United States Judo, Inc., UnitedStates Judo Association, Inc., 50th State Judo Association, Inc., Honolulu Judo Club, Cedar Assembly of God and GS
Industries I agree:
1. I understand the nature of Judo activities and believe I am qualified to participate in such Activity. I also understand therules governing the sport of Judo.
2. I further acknowledge that prior to participating, I will inspect the mats, equipment, facilities, competition pools or
divisions, and the elimination or scoring system to be used, and if I believe anything is unsafe or beyond my capability, I will
immediately advise my coach, supervisor, and/or a tournament official of such conditions and refuse to participate.
3. I acknowledge and fully understand that I will be engaging in a contact sport that might result in serious injury, illness ordisease, including permanent disability or death, and severe social and economic losses due not only to my own actions, inactions ornegligence, but also to the actions, inactions, or negligence of others, including United States Judo Federation, together with their affiliatedclub, their respective administrators, directors, officers, agents, coaches, and other employees or volunteers of the organization, eventofficials, medical personnel, other participants, their parents, legal guardians, supervisors and coaches, sponsoring agencies, sponsors,advertisers, and if applicable, owners, lessors, and lessees of premises used in conducting the event (Releasees), the rules of the sport ofJudo, or conditions of the premises or of any equipment used. Further, I acknowledge that there may be other risks not known to me ornot reasonably foreseeable at this time.
4. Knowing the risks involved in the sport of Judo, I assume all such risks and accept personal responsibility for the damages
following such injury, illness, disease, permanent disability, or death.
5. I hereby release, waive, discharge and covenant not to sue the United States Judo Federation, Inc., USA Judo/UnitedStates Judo, Inc., United States Judo Association, Inc., 50th State Judo Association, Inc., Honolulu Judo Club, Cedar
Assembly of God and GS Industries, together with their affiliated clubs, their respective administrators, directors, officers, agents,coaches, and other employees or volunteers of the organization, event officials, medical personnel, other participants, their parents, legal
guardians, supervisors and coaches, sponsoring agencies, sponsors, advertisers, and if applicable, owners, lessors, and lessees of premises
used in conducting the event, all of whom are hereinafter referred to as “Releasees”, from any and all litigation expenses, attorney fees,loss, liability, damage or costs on account of injury, illness, disease, including permanent disability and death or damage to property,
caused or alleged to be caused in whole or in part by the negligent acts or omissions of the Releasees or otherwise to the fullest extent
permitted by law.

I HAVE READ THE ABOVE WARNING, WAIVER, AND RELEASE, UNDERSTAND THAT I HAVE GIVENUP SUBSTANTIAL RIGHTS BY SIGNING IT, AND KNOWING THIS, SIGN IT VOLUNTARILY ANDWITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE. I AGREE TO PARTICIPATEKNOWING THE RISKS AND CONDITIONS INVOLVED AND DO SO ENTIRELY OF MY OWN FREE WILL.
I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVEOBTAINED THE REQUIRED CONSENT OF MY PARENT/LEGAL GUARDIAN AS EVIDENCED BY THEIRSIGNATURE BELOW. I INTEND THIS TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALLLIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OFTHIS AGREEMENT IS HELD TO BE INVALID THAT THE BALANCE, NOTWITHSTANDING SHALLCONTINUE IN FULL FORCE AND EFFECT.
__________________________________
Participant______________________________
Participant’s Signature_________________Date

FOR PARENTS/LEGAL GUARDIANS OF PARTICIPANTS OF MINORITY AGE(UNDER AGE 18 AT TIME OF REGISTRATION)
This is to certify that I, as parent/legal guardian with legal responsibility for this participant, do consent and agree tohis/her release, as provided above, of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release andagree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child’s involvement
or participation including litigation expenses, attorney fees, loss, liability, damage or costs which may incur as the resultof the minor child’s participation in these programs as provided above, even if arising from their negligence, to thefullest extent permitted by law. I have instructed the minor participant as to the above warnings and conditions and theirramifications.
__________________________________
Parent/Legal Guardian
HJC Registration Forms January 2022.docx_________________________________
Parent/Legal Guardian’s Signature_____________Date

GRANT OF PUBLICITY RIGHTS & RELEASE OF CLAIMS
Please use one form per person.
I, the undersigned, hereby give Honolulu Judo Club and its agents, employees, successors, assigns, affiliates, andlicensees, the full and unrestricted right and permission, in perpetuity and throughout the world, to use my name and/orlikeness without previous notification or compensation. This right is granted to any and all uses of my name and/or likeness,whether captured by photograph, video, audio recording, or any other method, for any lawful purpose, including, but notlimited to, publicity, advertising, and community education, and in any manner or format, including, but not limited to, printed
materials, audio/video productions, and online formats (including email, websites, social media, and mobile marketing).
I hereby release, acquit, and forever discharge Honolulu Judo Club and its officers, directors, employees, agents, affiliates,and licensees from and against any and all claims, actions, causes of action, and liability, of any kind or nature, arising out of
any use of my name, likeness, or voice in any lawful manner pursuant to this document.
I waive any right to pre-approve or review any use of my name, likeness, or voice by Honolulu Judo Club pursuant to thisdocument.
I understand and agree that this Grant of Publicity Rights & Release of Claims will be construed in accordance with the lawsof the State of Hawaii and the United States of America and that if any portion of this Grant of Publicity Rights & Release ofClaims is held to be invalid, the balance shall continue in full force and effect.

I AM 18 YEARS OF AGE OR OLDERr

YESr

NO*

NAME (PRINT) ____________________________________________________________________________________ADDRESS _______________________________________________________________________________________
SIGNATURE ________________________________________________ DATE _______________________________HONOLULU JUDO CLUB WITNESS/AGENT (PRINT NAME) _______________________________________________WITNESS/AGENT TITLE ___________________________________________________________________________*If the person signing is under 18, consent must be given by a parent or legal guardian as follows:I hereby certify that I am the parent or legal guardian of the above-named minor. I have read and understand this Grant ofPublicity Rights & Release of Claims, and do hereby give my consent, without reservations, to the foregoing on behalf of theabove-named minor.
PARENT / LEGAL GUARDIAN NAME (PRINT) ___________________________________________________________
SIGNATURE ________________________________________________ DATE _______________________________*********************************************************************************r

PLEASE EXCLUDE THE FOLLOWING:

NAME (PRINT) ____________________________________________________________________________________
SIGNATURE ________________________________________________ DATE _______________________________PARENT / LEGAL GUARDIAN NAME (PRINT) ___________________________________________________________
SIGNATURE ________________________________________________ DATE _______________________________
Revised 7/16/21

HJC Registration Forms January 2022.docx

HONOLULU
JUDO CLUBBe Strong, Courageous and Gentle

COVID-19 LIABILITY WAIVERPARTICIPANT NAME: ________________________________________ DATE: ____________
I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still
recommend practicing social distancing.
I further acknowledge that Honolulu Judo Club has put in place preventative measures to reduce the spread of the Coronavirus/COVID19.
I further acknowledge that Honolulu Judo Club cannot guarantee that I will not become infected with the Coronavirus/Covid-19. I
understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions,or negligence of myself and others.
I voluntarily seek services provided by Honolulu Judo Club and acknowledge that I am increasing my risk to exposure to theCoronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending practice.
I attest that:•

I am/My child is not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever,chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.

•

I have/My child has not traveled internationally within the last 10 days, or I have/my child has obtained a negative result on aCOVID test upon returning to Hawaii, or I have/my child has been fully vaccinated.

•

I have/My child has not traveled to a highly impacted area within the United States of America in the last 10 days, or I have/mychild has obtained a negative result on a COVID test upon returning to Hawaii, or I have/my child has been fully vaccinated.

•I do not believe I have/my child has been exposed to someone with a suspected and/or confirmed case of theCoronavirus/COVID-19 in the past 10 days.

•I have/My child has not been diagnosed with Coronavirus/COVID-19 and not yet cleared as non-contagious by state or local
public health authorities.

•We are following all CDC recommended guidelines as much as possible and limiting my/our exposure to theCoronavirus/COVID-19.

I hereby release and agree to hold Honolulu Judo Club harmless from, and waive on behalf of myself/my child any and all causes ofaction, claims, demands, damages, costs, expenses and compensation for damage or loss to myself/child that may be caused by any act,or failure to act of the Judo Club, or that may otherwise arise in any way in connection with any services received from Honolulu JudoClub, its instructors and its agents from any liability or claim that I/my child may have against the Judo Club with respect to any bodily
injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from
Honolulu Judo Club. This Liability waiver and release extends to the Judo Club with all owners, partners, and employees.

PRINT PARENT NAME: _______________________________________ (PLEASE PRINT CLEARLY)
PARENT SIGNATURE: ______________________________________________ DATE: ______________ADULT PARTICIPANT SIGNATURE: ____________________________________DATE: ______________