EMERALD HILLS KARATE LLC

Tang Soo Do Program

Classes held at Young Israel of Hollywood-Ft. Lauderdale

LIABILITY WAIVER, ASSUMPTION OF RISK, AND RELEASE AGREEMENT

PARTICIPANT INFORMATION

Participant Name: ________________________________________ Date of Birth: ________________

Address: __________________________________________________________________________________

City: ________________________________ State: __________ Zip: ________________

Phone: ________________________________ Email: ________________________________________

Emergency Contact: ________________________________ Phone: ____________________________

Known Medical Conditions, Allergies, or Physical Limitations: ___________________________________

____________________________________________________________________________________________

PARENT/GUARDIAN INFORMATION (if participant is under 18)

Parent/Guardian Name: ______________________________________________________________________

Relationship to Participant: ____________________________ Phone: ____________________________

Email: ____________________________________________________________________________________

ASSUMPTION OF RISK

I acknowledge that participation in Tang Soo Do martial arts instruction and related activities involves inherent risks of physical injury, including but not limited to: bruises, sprains, strains, fractures, concussions, and other injuries that may result from strikes, kicks, blocks, falls, throws, sparring, contact with other participants, or the use of training equipment such as punching bags, kicking pads, and other martial arts training tools. I understand that these risks exist regardless of the precautions taken by instructors and staff.

I voluntarily assume all risks associated with participation in Emerald Hills Karate LLC programs, including risks arising from the condition of the training facility at Young Israel of Hollywood-Ft. Lauderdale, and I understand that this assumption of risk extends to all activities conducted under the supervision of Emerald Hills Karate LLC, whether on-site or at any approved off-site location.

WAIVER AND RELEASE OF LIABILITY

In consideration of being permitted to participate in the Tang Soo Do program offered by Emerald Hills Karate LLC, I, on behalf of myself and/or my minor child, and on behalf of my/our heirs, assigns, personal representatives, and next of kin, hereby release, waive, discharge, and covenant not to sue Emerald Hills Karate LLC, its owners, officers, instructors, employees, volunteers, and agents (collectively, the “Released Parties”) from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant during or as a result of participation in the program, whether caused by the negligence of the Released Parties or otherwise.

This release further extends to Young Israel of Hollywood-Ft. Lauderdale, its officers, directors, employees, and agents, in their capacity as the host facility for the program.

MEDICAL AUTHORIZATION

In the event of an injury or medical emergency involving the participant, I authorize Emerald Hills Karate LLC and its instructors to obtain emergency medical treatment, including but not limited to first aid, CPR, ambulance transport, and hospital care. I understand that I will be financially responsible for any and all medical expenses incurred on behalf of the participant. I confirm that the participant is physically fit to engage in martial arts training and has no medical conditions that would prevent safe participation, except as disclosed above.

CODE OF CONDUCT

I agree that the participant will follow all rules, guidelines, and instructions provided by Emerald Hills Karate LLC instructors. I understand that Emerald Hills Karate LLC reserves the right to dismiss any participant whose behavior is disruptive, dangerous, or disrespectful, without refund. Physical techniques learned in the program are to be used only in a supervised training environment or in genuine self-defense situations, never for aggression or bullying.

PHOTO, VIDEO, AND SOCIAL MEDIA RELEASE

Emerald Hills Karate LLC may photograph or video record classes, events, promotions, and activities for use in marketing materials, social media platforms (including but not limited to Instagram, Facebook, TikTok, YouTube, and the Emerald Hills Karate website), newsletters, flyers, and other promotional purposes. No participant will be identified by full name in connection with any published photo or video without separate written consent.

Please select one of the following:

_____ I GRANT permission for the participant’s photo, video, and/or likeness to be used by Emerald Hills Karate LLC for promotional and marketing purposes as described above.

_____ I DO NOT GRANT permission for the participant’s photo, video, and/or likeness to be used by Emerald Hills Karate LLC for promotional and marketing purposes. I understand that Emerald Hills Karate LLC will make reasonable efforts to exclude the participant from published media, but that incidental appearance in group photos or videos may occur.

GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the State of Florida. Any disputes arising under this Agreement shall be resolved in the courts of Broward County, Florida.

ACKNOWLEDGMENT AND AGREEMENT

I have read this Liability Waiver, Assumption of Risk, and Release Agreement in its entirety. I fully understand its terms and conditions. I understand that I am giving up substantial rights, including the right to sue. I acknowledge that I am signing this agreement freely and voluntarily, and I intend my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law. If signing on behalf of a minor participant, I represent that I am the parent or legal guardian of the participant and have the legal authority to execute this agreement on the minor’s behalf.

PARTICIPANT SIGNATURE (if 18 or older):

Signature: ________________________________________ Date: ________________

Printed Name: ________________________________________

PARENT/GUARDIAN SIGNATURE (if participant is under 18):