ITA Spring Seminar Pre-Registration

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Please indicate your attendance for Spring Seminar:
(Check all that apply)

Please indicate your attendance for Spring Seminar:
(Check all that apply) Full Weekend (Thurs-Sun) Friday Saturday Sunday
Will you be attending Hajime with the group on Saturday night?

Will you be attending Hajime with the group on Saturday night? Yes, I will be attending No, I will not be able to attend
HEALTH INSURANCE INFORMATION
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EMERGENCY CONTACT INFO
For your safety, please provide us with the best person to contact in the event of an emergency.
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Emergency Contact Phone Emergency Contact Phone - ### - ### ####
HOLD HARMLESS AGREEMENT AND WAIVER OF LIABILITY
In consideration of the sponsorship of this Aikido Seminar by Minnesota Aiki Shuren Dojo; And in further consideration of my participation in this Aikido Seminar;
I recognize that the practice of Aikido shares the hazards of any martial art or other strenuous physical activity as well as possible exposure to the COVID-19 coronavirus. I hereby agree to assume ALL risk of injury and loss that may arise as a result of participating in this activity, and further agree to hold: ISD 728, and its agents, Minnesota Aiki Shuren Dojo and its members, as well as Mark Larson, harmless for any injury or loss that arises as a direct or indirect result of any act or omission of any third party.

I hereby release and hold harmless ISD 728, its directors, regents & trustees, agents, and employees, Minnesota Aiki Shuren Dojo and its members, as well as Mark Larson, instructor for above named event, for any personal injuries I may sustain as a result of my participation in the activities associated with this Aikido Seminar.

By signing below, I agree to each statement above and release ISD 728 and it’s agents, Minnesota Aiki Shuren Dojo and its members, and Shihan Mark Larson from any and all liability for any injury or unintentional exposure or harm due to COVID-19.
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ITA Spring Seminar Pre-Registration

HEALTH INSURANCE INFORMATION

EMERGENCY CONTACT INFO

HOLD HARMLESS AGREEMENT AND WAIVER OF LIABILITY