LIA New Student Registration and Waiver

School Registration and Waiver Form

Welcome to the Long Island Aikikai! We're thrilled to have you join us on the mat.

This form serves two important purposes:

Registration: Collect essential contact information.
Safety: Standard liability waiver for insurance purposes.

Completing this form does not create any membership obligation.

Questions? info@liaikikai.com or (586) 436-2454.

* Required fields

Which program are you interested in? *

Aikido Children's Aikido Weapons Iaido Special Event Both Aikido & Iaido Funnel Course I'm not sure

Student Information

Email * We'll use this to contact you.

First Name *

Middle Name

Last Name *

Mobile Phone * Include country code for international numbers.

Home Phone

Country *

Street Address *

Address Line 2

City *

State *

ZIP Code *

Birthday *

Student Demographic Information

Gender *

This captures gender identity, not biological sex.

Male Female Non-Binary I prefer not to answer

Racial/Ethnic Categories *

Check all that apply.

American Indian or Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander White I prefer not to answer

Highest Education Level *

Less than high school High school graduate (includes equivalency) Some college, no degree Associate's degree Bachelor's degree Graduate or professional degree Ph.D. I prefer not to answer

Occupation

How did you hear about us? *

Have you ever practiced martial arts before? *

Yes No

Emergency Contact Information

Emergency Contact Name *

Emergency Contact Phone *

Emergency Contact Relationship *

Parent Grandparent Child Sibling Spouse Partner Family (other) Friend Parent or Guardian

Assumption of Risk; Waiver, Release & Indemnity

(Please read carefully before signing)

1. SERVICES PROVIDED. I understand that Long Island Aikikai Dojo LLC ("LIA") provides training in Aikido, Jujitsu, Iaido, and related martial arts ("Training").

2. PARTICIPATION. I voluntarily agree to participate in Training with full knowledge of inherent risks.

3. ASSUMPTION OF RISK. I acknowledge Training entails known and unanticipated risks including but not limited to: cuts, bruises, sprains, broken bones, concussion, paralysis, or death. I voluntarily accept all risks.

4. WAIVER, RELEASE & INDEMNITY. I permanently discharge and release LIA and its affiliates from any liability for injury arising from my participation. I waive any cause of action and agree to indemnify LIA against any claims.

5. INSURANCE. I represent that I have adequate insurance or means to cover any injury.

6. INSTRUCTORS. I acknowledge instructors seek safety but are not infallible.

7. VENUE & CHOICE OF LAW. This agreement is governed by New York law. Any action will be commenced in Suffolk County, New York.

8. PHOTOS & FILMING. I consent to LIA taking photos/video and waive rights to such materials.

9. CONFIDENTIALITY. Information will be kept confidential and not released to 3rd parties.

10. BINDING EFFECT. I have read and understand this document and agree to be bound by its terms. Contact info@liaikikai.com or (586) 436-2454 with questions.

I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD ALL TERMS AND AM VOLUNTARILY GIVING UP SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE.

Executed by: *

If under 18, parent/guardian must sign.