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Aikido at KSA
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615-720-4820

4908 Charlotte Pike
Nashville, TN 37209

info@ksamartialacademy.com

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Adult Training Waiver
Must be signed by any and all adults wishing to try out a free class or train at KSA Martial Academy.

"*" indicates required fields

MM slash DD slash YYYY
Participant/ Student Name*
Do you have a nick name, go by your middle name, is there a specific pronunciation of your name? Let us know here.
Personal Pronouns*
Please select all that apply.
MM slash DD slash YYYY
If "Other" was selected, please list your Personal Pronouns here.
Contact Email*
Please enter an email where you can receive class notifications, updates, and which, if you join, you will use to access your account with us.
Please enter a number we can use to contact you, via phone or text, in case of emergency class cancelations or other important notifications.
Equity and Inclusion*
We are actively seeking to create and support truly diverse membership, including but not limited to members of all racial and ethnic backgrounds, all gender identities, all sexual orientations, and any other identity characteristics to strengthen the work and the reach of the organization.

We will not tolerate or allow discrimination against any of our members or participants. If there are claims of discrimination, KSA Martial Academy will adhere to a three-step process, consisting of an official investigation into the suit, remediation of the wrongful behavior(s), and a resolution policy. When a claim is brought forth, a third party will be brought in to validate and substantiate the claim. If a claim is found to be groundless or to have been made out of malice, the reporting member will be suspended from membership for no less than one year up to permanent expulsion from the organization.
Training Waiver*
I, the undersigned, HEREBY WAIVE AND RELEASE, indemnify, hold harmless and forever discharge KSA Martial Academy and its agents, employees, officers, directors, affiliates, successors and assigns, of and from any and all claims, demands, debts, contracts, expenses, causes of action, lawsuits, damages and liabilities, of every kind and nature, whether known or unknown, in law or equity, that I ever had or may have, arising from or in any way related to my participation in any of the events or activities conducted by, on the premises of, or for the benefit of, KSA Martial Academy provided that this waiver of liability does not apply to any acts of gross negligence, or intentional, willful or wanton misconduct.

I understand that the activities that I will participate in are inherently dangerous and may cause serious or grievous injuries, including, but not limited to, bodily injury, damage to personal property, sprains, contusions, abrasions, broken bones, and, in extreme cases, paralysis and/or death. Due to the potential hazards associated with the activities of the program, I/We recognize the importance of following the instructions regarding fitness/martial arts/ self-defense techniques and other rules associated with the program.

On behalf of myself, my heirs, assigns and next of kin, I waive all claims for damages, injuries and death sustained to me or my property, that I may have against the aforementioned released party to such activity.

By this Waiver, I assume any risk, and take full responsibility and waive any claims of personal injury, death or damage to personal property associated with KSA Martial Academy including but not limited to receiving lessons at the facility, using the facility and its equipment, practicing and/or engaging in marital arts or other related activities on and off the premises.

This WAIVER AND RELEASE contains the entire agreement between the parties, and supercedes any prior written or oral agreements between them concerning the subject matter of this WAIVER AND RELEASE. The provisions of this WAIVER AND RELEASE may be waived, altered, amended or repealed, in whole or in part, only upon the prior written consent of all parties.

The provision of this WAIVER AND RELEASE will continue in full force and effect even after the termination of the activities conducted by, on the premises of, or for the benefit of KSA Martial Academy, whether by agreement, by operation of law, or otherwise.

I have read, understand and fully agree to the terms of this WAIVER AND RELEASE. I understand and confirm that by signing this WAIVER AND RELEASE I have given up considerable future legal rights. I have signed this Agreement freely, voluntarily, under no duress or threat of duress, without inducement, promise or guarantee being communicated to me. My signature is proof of my intention to execute a complete and unconditional WAIVER AND RELEASE of all liability to the full extent of the law. I am 18 year of age or older and mentally competent to enter into this waiver.
Infectious Disease and Injury Agreements*
The World Health Organization has declared the novel Coronavirus (COVID-19) a worldwide pandemic, and more may be on the rise. Due to the capacity to transmit from person-to-person, the government sets recommendations, guidelines, and some prohibitions which KSA Martial Academy, LLC will observe as issued.

In consideration of my participation in the foregoing, the undersigned acknowledge and agree to the following:
Physical Appearance*
Health Check*
High Risk Travel*
High Risk Travel*
Recent Diagnosis*
CDC Recommendations Agreements*
Personal Responsibility*
Following the pronouncements above I hereby declare the following:
Waiver*
Indemnification*
Let us know when you are coming in so that our Instructors will know to expect you.
MM slash DD slash YYYY
Second date choice for free trial class.
MM slash DD slash YYYY
Emergency Contact*
Acknowledgement*
Self (if 18 years or older)/ Parent/ Legal Guardian(s) only
This field is for validation purposes and should be left unchanged.

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