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Membership Application

IndividualDojoAssociation/Federation

Date of Birth 
Is karate your full-time job? YesNo
Do you run a dojo? YesNo



Waiver
By submitting this application, I knowingly and without duress, do voluntarily submit my or my child(s) entry into the International Karate-Do Organization, USSSA Karate Program, any of its affiliates and/or associates, board members, and directors, hereinafter referred to as “IKO”. I hereby assume all risk of physical and mental injuries, disabilities, and losses which may result from or in connection with my participation in training and or competition. Acting for myself, heirs, children's personal representatives, and assignee, I do hereby release IKO, its directors, officers, agents, representatives, officials, employees, volunteers, and all other related members from all claims, action, suits, and controversies at law or in equity by reason of any matter, cause or thing whatsoever that I may sustain as a result of or in connection with my participation in any events in association directly or indirectly with IKO. I also understand any medical attention or treatment afforded to me by IKO, its officers, agents, representatives, officials, employees, volunteers, instructors, or associates and all other related members will be of the first aid type only, and I hereby release IKO and all other related members and/or affiliates from any liability for such aid. I agree that my performance attendance and participation at any event may be filmed or otherwise recorded or telecast live. I consent to the use by IKO of my name, likeness, voice, poses, pictures, and biographical data concerning fully or in parts, in any form or language, with or without other material, throughout the world, without limitation, for television, radio, video, theatrical motion pictures, or any other medium by devices now known or hereafter responsibility and associated liability for infringement of such rules, Additionally, I am fully aware of my or my child(s) personal medical condition and hereby certify that I am mentally and physically fit to compete. By submitting this application, I certify that I have read and fully understand this waiver.

I understand and agree.

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