WAIVER

Vision Quest Martial Arts & Fitness

3079 HIGHWAY 56, BINBROOK, ON  LOR 1C0 • 905-515-3133

PHYSICAL ACTIVITY READINESS QUESTIONNAIRE

• Has your doctor ever said that you should only do medically supervised physical activity? *  YES     NO
• Has your doctor ever said that you have a heart condition OR high blood pressure? * YES     NO
• Do you feel pain in your chest at rest, during your daily activities of living, OR when you do physical activity? * YES     NO
• Do you lose balance because of dizziness OR have you lost consciousness in the last 12 months? Please answer NO if your dizziness was associated with over-breathing (including during vigorous exercise). YES     NO
• Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure)? * YES     NO
• Are you currently taking prescribed medications for a chronic medical condition? * YES     NO
• Do you currently have (or have had within the past 12 months) a bone, joint, or soft tissue (muscle, ligament, or tendon) problem that could be made worse by becoming more physically active? Please answer NO if you had a problem in the past, but it does not limit your current ability to be physically active. * YES     NO

PLEASE LIST CONDITIONS HERE

PLEASE LIST CONDITION(S) AND MEDICATIONS HERE:

If you answered YES to any of the above questions, you should seek further information before becoming more physically active or engaging in a fitness appraisal.

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If you answered NO to all of the questions above, you are cleared for physical activity.

Start becoming more physically active – start slowly and build up gradually. Follow International Physical Activity Guidelines for your age (www.who.int/dietphysicalactivity/en/). You may take part in a health and fitness appraisal. If you are over the age of 45 yr and NOT accustomed to regular vigorous to maximal effort exercise, consult a qualified exercise professional before engaging in this intensity of exercise. If you have any further questions, contact a qualified exercise professional.

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PHOTOGRAPHY/VIDEO RELEASE

Participants involved in any activities offered by Vision Quest Martial Arts and Fitness may be photographed or videotaped during training. The undersigned hereby consents to the use of these photographs and/or videos without compensation, on the Vision Quest Martial Arts and Fitness website or in any editorial, promotional or advertising material produced and/or published by Vision Quest Martial Arts and Fitness.

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WAIVER & RELEASE OF LIABILITY

Express assumption of risk: I, the undersigned, am aware that there are significant risks involved in all aspects of physical training. These risks include, but are not limited to: falls which can result in serious injury or death; injury or death due to negligence on the part of myself, my training partner, or other people around me; injury or death due to improper use or failure of equipment; strains and sprains. I am aware that any of these above mentioned risks may result in serious injury or death to myself and or my partner(s). I willingly assume full responsibility for the risks that I am exposing myself to and accept full responsibility for any injury or death that may result from participation in any activity or class while at, or under direction of Vision Quest Martial Arts & Fitness. I acknowledge that I have no physical impairments, injuries, or illnesses that will endanger me or others. Martial Arts training can involve a wide variety of skills. While practicing these skills, students may have contact with any portion of the body. The groin may be the target of kicks, strikes, and grabs. The chest, buttocks, groin or any part of the body may be contacted by any part of the training partner’s body during training. When male and female students train together, or when adult and minor students train together, the purpose and intent of this training is to learn and practice martial arts and/or self defense. The students are expected to conduct themselves accordingly. Vision Quest Martial Arts & Fitness seeks to use highly trained, professional instructors with expertise and experience both in the arts we teach, and in teaching. Classes may be taught by the head instructor, a junior instructor, a senior student, or a special guest instructor. The choice of instructor is left to the discretion of the school. Martial Arts is a potentially dangerous activity. Bumps, bruises, scrapes, and soreness are commonplace, and most students will encounter this sort of minor injury from time to time in their training. More serious injuries are possible including sprains, twists, pulls, and injuries of similar magnitude, and students are expected to sustain these injuries less frequently. The possibility of more serious injuries including but not limited to broken bones, torn ligaments, spinal injuries, or even death is in existence. This remains, despite safety precautions, a remote possibility and we do not hold Vision Quest Martial Arts & Fitness and its instructors responsible for. Even if the instructor says no serious injuries have ever happened in this school or involving any of its instructors, I understand that this does not mean there is no possibility for harm and/or serious injury. There remains, despite safety precautions, the remote possibility of crippling or death, though this certainly is not expected in any of our Martial Arts classes.

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RELEASE

In consideration of the above mentioned risks and hazards and in consideration of the fact that I am willingly and voluntarily participating in the activities offered by Vision Quest Martial Arts & Fitness, I, the undersigned hereby release Vision Quest Martial Arts & Fitness, their principals, agents, employees, and volunteers from any and all liability, claims, demands, actions or rights of action, which are related to, arise out of, or are in any way connected with my participation in this activity, including those allegedly attributed to the negligent acts or omissions of the above mentioned parties. This agreement shall be binding upon me, my successors, representatives, heirs, executors, assigns, or transferees. If any portion of this agreement is held invalid, I agree that the remainder of the agreement shall remain in full legal force and effect. If I am signing on behalf of a minor child, I also give full permission for any person connected with Vision Quest Martial Arts & Fitness to administer first aid deemed necessary, and in case of serious illness or injury, I give permission to call for medical and or surgical care for the child and to transport the child to a medical facility deemed necessary for the well being of the child. I understand the nature of physical contact in Martial Arts training, and I understand that I have the right to immediately withdraw from any exercise or drill in which the conduct of any party seems beyond the scope of training or makes me feel uncomfortable. I agree to abide by school etiquette in all matters pertaining to training, and I shall not in any way conduct myself inappropriately or take inappropriate advantage of the contact that Martial Arts provide.

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INDEMNIFICATION

The participant recognizes that there is risk involved in the types of activities offered by Vision Quest Martial Arts & Fitness. Therefore the participant accepts financial responsibility for any injury that the participant may cause either to him/herself or to any other participant due to his/her negligence. Should the above mentioned parties, or anyone acting on their behalf, be required to incur attorney’s fees and costs to enforce this agreement, I agree to reimburse them for such fees and costs. I further agree to indemnify and hold harmless Vision Quest Martial Arts & Fitness, their principals, agents, employees, and volunteers from liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in activities offered by Vision Quest Martial Arts & Fitness, at the main building or abroad. This includes but is not limited to parks, recreational areas, playgrounds, areas adjacent to main building, and/or any area selected for training by Vision Quest Martial Arts & Fitness. If I am a parent/guardian, I agree not to bring any claim or lawsuit against the school, instructors, guest, students, landlord, or any other parties on behalf of my child for any injury or harm sustained at Vision Quest Martial Arts & Fitness. If I am an adult, not needing consent, I also agree to not bring any form of legal action against this school for injuries sustained during martial arts classes or in the Vision Quest Martial Arts & Fitness premises. By assuming that there is risk involved in these activities, I completely absolve Vision Quest Martial Arts & Fitness, its instructors, landlord, students and guests and all other parties of liability for my harm, unless caused by intentional criminal intent.

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Signature

I have read and understood the foregoing assumption of risk, and release of liability and I understand that by signing it obligates me to indemnify the parties named for any liability for injury or death of any person and damage to property caused by my negligent or intentional act or omission. I understand that by signing this form I am waiving valuable legal rights.

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