I understand that there are risks and dangers inherent in participating and/or
receiving instruction in (AIKA Karate, Kick-boxing and self-defense) hereinafter "Activity".

I also understand that in order to be allowed to participate and/or receive
instruction in Activity, I must give up my rights to hold The AIKA liable for any injury or
damage which I may suffer while participating and/or receiving instruction in Activity.

Knowing this, and in consideration of being permitted to participate and/or receive
instruction in Activity, I hereby voluntarily release The AIKA from any and all liability
resulting from or arising out of my participation and/or receipt of instruction in Activity.

I understand and agree that I am releasing not only the entities set forth in the
paragraph above, but also the officers, instructors, participants and property owners
of those entities.

I understand and agree that this Waiver/Release will have the effect of releasing,
discharging, waiving and forever relinquishing any and all actions or causes of
action that I may have or have had, whether past, present or future, whether known
or unknown, and whether anticipated or unanticipated by me, arising out of my
participation and/or receipt of instruction in Activity with the AIKA, its officers,
property owners or instructors.

I understand and agree that this Waiver/Release applies to personal injury, property
damage, or wrongful death, which I may suffer, even if caused by the acts or
omissions of others.

I understand and agree that by signing this Waiver/Release, I am assuming full
responsibility for any and all risk of death or personal injury or property damage
suffered by me while participating and/or receiving instruction in Activity.

I understand and agree that this Waiver/Release will be binding on me, my spouse,
my heirs, my personal representatives, my assignees, my children and any guardian
for said children.

I understand and agree that by signing this Waiver/Release, I am agreeing
to release, indemnify and hold The AIKA, its officers, instructors, property owners or
active participants harmless from any and all liability or costs, including attorneys
fees, associated with or arising from my participation and/or receipt of instruction
in Activity.

I understand and agree that if I am signing this Waiver/Release on behalf of my
minor child, that I will be giving up the same rights for said minor as I would be
giving up if I signed this document of my own behalf.

I acknowledge that I have read this Waiver/Release Agreement and that I understand
the words and language in it. I have been advised of the potential dangers
incidental to participating and/or receiving instruction in Activity .

Dated: _________________________,20________
Print Name: ____________________________________
Sign Name: ____________________________________
Witness: ____________________________________ Sign init________

Parent/Guardian Release:
I am the parent or legal guardian of the minor ___________________________,
and I am signing this Waiver/Release on behalf of said minor.

Print name of Parent: _____________________________________

Signature of Parent: _______________________________________