I am

Authorization

All practitioners of Karate in New Brunswick are required to hold membership with Karate NB and Karate Canada at $60.00 per year. Please note this is not optional for Karatekas and no monies for membership benefit Shinzen Karate. This is strictly for Karate NB and Karate Canada membership. We use Square as our payment processor. Please note that Square charges 3.4% on all transactions made.

I authorize Shinzen Karate Dojo to charge my credit card $60.00 for my yearly membership renewal with Karate Canada / NB

I authorize Shinzen Karate Dojo to charge my credit card for my chosen class selection

Cancellation policy

Please note that you will only be charged for the month following the cancellation date.

Authorization

I understand and agree that in participating in any Karate class, workshop, rehearsal or performance, there is a possibility of physical injury or death. I voluntarily agree, therefore, to assume all risks and responsibility for any such injury or accident, which might occur to me or my child during any of Shinzen's classes, rehearsals, performances, or activities. I also exempt, release, and indemnify Shinzen, its owners, agents, volunteers, assistants, employees, faculty members, and/or students from any and all liability claims, demands, or causes of action whatsoever from any damage, loss, injury, or death to me, my children, or property which may arise out of or in connection with participation in any classes or activities conducted by Shinzen. I further hereby voluntarily agree to waive my rights and that of my heirs and assigns to hold Shinzen, its owners, agents, volunteers, assistants, employees, faculty members, and/or students liable for such damage, loss, injury, or death. I understand that I should be aware of my physical limitations and agree not to exceed them. If I am signing this waiver for my children, I certify that I am the parent or legal guardian and have the right to waive these rights. Permission is granted to Shinzen to use photographs of members for publicity purposes. The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, provincial, and local governments and federal and provincial health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. Shinzen has put in place preventative measures to reduce the spread of COVID-19; however, Shinzen cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending Shinzen could increase your risk and your child(ren)’s risk of contracting COVID-19. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending Shinzen and that such exposure or infection may result in personal injury, illness, permanent disability or death. I understand that the risk of becoming exposed to or infected by COVID-19 at Shinzen may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Shinzen employees, instructors, and program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at Shinzen Karate or participation in Shinzen classes (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless Shinzen, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of Shinzen, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in Shinzen.

Please type in your full name. This acts as your Electronic Signature.