FCT: Waiver & Release of Liability COVID19
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  • MEDICAL INFORMATION

  • PARENT/Guardian INFORMATION

  • If unknown, put "unknown"
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  • Agreement of Release

    I the person named below being above the age 18, or the legal guardian of the person named below who is under 18, in consideration of the services of First Coast TaeKwonDo any rate charged for those services, and the right to engage in activities at the facilities provided by First Coast TaeKwonDo at 7540 103rd Street Ste #109, as a participant; hereby acknowledge, agree, promise, and covenant with First Coast TaeKwonDo and all other persons or entities which may be connected to First Coast TaeKwonDo as follows:
    1. IN CONSIDERATION OF THE BENEFITS DERIVED FROM FIRST COAST TAEKWONDO, I AGREE TO INDEMNIFY, RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE FIRST COAST TAEKWONDO, OR ITS INSTRUCTORS, their agents, servants, and employees, and assigns and any and all other persons or entities which are related to, arise out of or are in any way connected with participation in TAEKWONDO instructed by First Coast TaeKwonDo. For the purposes herein, they shall be referred to as “Releasees,” from all liability to the named participant, or the legal guardian of the named participant, his or her personal representatives, assigns, heirs, and next of kin for any and all loss or damage, and any claim or demands therefore. On account of injury or illness to the person or property or resulting in the death of the named participant, whether caused by the negligence of the “Releasee,” or otherwise while the participant is participating in TaeKwonDo, as supervised by the Releasees, whether it be active participation or mere observance.
    2. I and/or MY LEGAL GUARDIAN EXPRESSLY ACKNOWLEDGE, UNDERSTAND, AND APPRECIATE, AS ANY CAREFUL, CONSCIENTIOUS, EVEN TEMPERED, AND HONEST “REASONABLE PERSON” WOULD, THE FORESEEABLE RISKS WHICH MAY BE INVOLVED IN THE PARTICIPATION OF TAEKWONDO, Which by its nature includes strenuous exercises, and BODY CONTACT. I and/or MY LEGAL GUARDIAN also expressly consents to confront these foreseeable dangers, and further agrees, understands and recognizes that these risks may result in SERIOUS INJURY or illness, including bruises, bloody noses, broken bones, and/or DEATH, and/or property damage. I further understand and acknowledge that these risks may result in personal claims against the Releasees, First Coast TaeKwonDo, or claims against me by other participants and third parties, but I expressly covenant not to sue the Releasees for any damages which may result from the named participant’s participation in TaeKwonDo.
    3. I and/or MY LEGAL GUARDIAN HEREBY FORESEE THE RISKS OF AND ASSUME FULL RESPONSIBILITY FOR ANY BODILY INJURY, including bruises, bloody noses, broken bones, or other serious injury resulting in death or property damage relating to the duty of care of the releasess or otherwise, while participating in TaeKwonDo supervised by the releasees. I and/or my legal guardians further expressly agree that the foregoing Release, Waiver, and Indemnity Agreement is intended to be as broad and inclusive as is permitted by the laws of the state of Florida or the law of the province or state in which an event is conducted and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
    4. I and/or MY LEGAL GUARDIAN(S) HAVE READ AND VOLUNTARILY SIGNED THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agrees that no oral representations, statements, or inducements apart from the foregoing written agreement have been made. By voluntarily affixing my signature below, I warrant that I have read the entire Agreement and understand all of the foregoing: IN SIGNING THIS DOCUMENT, I FULLY RECOGNIZE THAT IF ANYONE IS HURT OR PROPERTY IS DAMAGED WHILE I AM PARTICIPATING IN TAEKWONDO INSTRUCTED BY FIRST COAST TAEKWONDO, I WILL HAVE NO RIGHT TO MAKE CLAIM OR FILE A LAWSUIT AGAINST FIRST COAST TAEKWONDO, ITS OFFICERS, AGENTS, EMPLOYEES, OR SUPPORTERS, EVEN IF THEY OR ANY OF THEM FAILED THEIR DUTY OF CARE AND WERE NEGLIGENT ANY BODILY INJURY OR PROPERTY DAMAGE.

    COVID 19 RELEASE:
    • In consideration of being allowed to participate in any way at First Coast Taekwondo, related events and activities, the undersigned acknowledges, appreciates, and agrees that:
    1. The risks of injury and illness (ex: communicable diseases such as MRSA, influenza, and COVID-19) from the activities involved in this program are significant, potentially life-threatening, and while particular rules, equipment, and personal discipline may reduce these risks, the risks of serious injury and illness do exist; and,
    2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,
    3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,
    4. I acknowledge that I am aware that there are risks to me of exposure to directly or indirectly arising out of, contributed to, by, or resulting from:
     An outbreak of any and all communicable disease, including but not limited to, the virus “severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)”, which is responsible for Coronavirus Disease (COVID-19) and/or any mutation or variation thereof;
    5. In consideration of having the opportunity to participate as either a student or observer at First Coast Taekwondo, and in acknowledging that I am aware of and willing to assume the risks associated with this activity, I hereby voluntarily agree to waive, hold harmless and indemnify First Coast Taekwondo and its trustees, agents, volunteers and employees from any and all claims, demands, damages and causes of action of any nature whatsoever arising out of ordinary negligence which I, my heirs, my assigns or successors may have against them for, on account of, or by reason of my participation in the above activities. I indicate my agreement to this hold harmless elective noted below.
    • I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

    This is to certify that I, as parent/guardian with legal responsibility for this participant, have read and explained the provisions in this waiver/release to my child/ward including the risks of the activity and his/her responsibilities for adhering to the rules and regulations. Furthermore, my child/ward understands and accepts these risks and responsibilities. I for myself, my spouse, and child/ward do consent and agree to his/her release provided above for all the Releasees and myself, my spouse, and child/ward do release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child’s/ward’s involvement or participation in these activities as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law.
  • This signature must be that of the individual "signing" this document electronically, otherwise it constitutes forgery under s.831.06, Florida Statutes
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