Guest Instructor Registration

Guest Instructor Event Registration

♱ Health ♱

♱ Awareness ♱

♱ Freedom ♱

"Now, three weeks after the workshop, I fully realize how much I learned, both theoretically and practically. And what is more important, I have very clear instruction on how I can continue mastering the fundamental skills on my own."

(Father, Software Architect, 44)

I-90 Training Center Waiver

Release of Liability

WARNING, WAIVER OF CLAIMS, RELEASE OF LIABILITY, INDEMNITY AGREEMENT, AGREEMENT TO MATRICULATE AND ELECTRONIC AND/OR PHOTO/VIDEO RELEASE

Between training applicant and Systema NW, I-90 Training Center, Kaizen Taki, Brian King, Vali Majd, Pacific Coast Systema, Russian Martial Art Systema Headquarters, hereinafter collectively referred to as SYSTEMA NW.

Please read carefully before signing.

I, the undersigned, do hereby:

1. Agree that before participating in training at SYSTEMA NW or at any events away from main school, I will inspect surfaces, facilities and equipment to verify their safety and advise my instructors and decline to participate if deemed unsafe.

2. Understand and acknowledge that all martial arts activities are physical contact exercises in which physical injury or fatal consequences as well as property damage can occur, due not only to my own negligence, action or interaction, but also the actions of others. Furthermore I acknowledge that there may be risks, known to me or not reasonably predictable.

3. Assume all risks involved in the practice of martial arts.

4. Enter on my own free will into premises and classes, demonstrations, training and competition understanding and abiding by the rules promulgated by my instructors, coaches and officials.

5. Certify that I am in good health, general physical conditions with no limitations to impair my performance, mentally or physically of the prescribed activities of myself and of others.

6. Grant permission the event of injury to have medical assistance administered by instructors, coaches and officials.

7. Acknowledge that the martial arts I learn are potentially dangerous and could result in serious injury or fatal outcome to myself and others. I hereby forever release, waive, discharge and covenant not to sue SYSTEMA NW their principals, staff, directors, agents, instructors, coaches, volunteers, medical personnel or any other SYSTEMA NW personnel, other participating martial arts organizations, affiliated clubs/ schools, administrators, volunteers, other participants, their parents or guardians, supervisors, instructors coaches, sponsoring organizations and/ or any other individuals and/ or entities for any and all injuries including death or damage incurred while entering or in the premises while participating in the classes, practices, demonstrations, training and competitions at or away from the premises. I further agree to indemnify and hold harmless, SYSTEMA NW, its principals, instructors, supervisors, and others of SYSTEMA NW, against any and all claims, liability and damages that may result from my use of the martial arts or someone else’s use of the martial arts on me.

8. I (an adult as defined by local and state laws) do agree to all the above statements, conditions, waivers, indemnifications, and consent to participate under the above conditions. I/ We as parents or legal guardians of a minor have instructed this minor of the provisions hereof and consent to the minor’s participation. I/We additionally confirm and agree to all and adopt and ratify as my/ our own all the rules, regulations, representations, waivers, releases, indemnifications, etc. included herein.

9. I hereby authorize Kaizen Taki and SYSTEMA NW and those acting pursuant to its authority to photograph, video tape, or use any other electronic method of recording my likeness and/or voice to be used at Systema NW’s discretion in Systema-related publications and/or web sites.

10. I hereby give Kaizen Taki and SYSTEMA NW the absolute right and permission, without restrictions, to make, copyright, and/or use, re-use, or publish said photographs/video footage of me in which I may be included in whole or in part, and waive any right to inspect and/or approve the finished printed materials, videos and/or web sites where my image appears. I further consent that my name and identity may be revealed therein or by descriptive text or commentary.

11. I release Kaizen Taki and SYSTEMA NW and those acting pursuant to its authority from liability for any violation of any personal or proprietary right I may have in connection with such use. I understand that all such recordings, in whatever medium, shall remain the property of Kaizen Taki and SYSTEMA NW. 

12. I waive any right to compensation for my appearance in these printed documents, videos or web sites in any and all future uses of the photographs and/or video footage.

Event Registration

Participant Information
Name *
Name
Date of Birth *
Date of Birth
You must be at least 18 years of age to participate in training at Systema NW.
Phone *
Phone
Address *
Address
Current address, no P.O. Box accepted.
Event Information
Cash and Square credit card payments for early registration are for current I-90 Members only.
Emergency Information
DUE TO THE POTENTIALLY DANGEROUS NATURE OF SYSTEMA TRAINING PLEASE PROVIDE THE REQUESTED EMERGENCY INFORMATION.
Emergency Contact *
Emergency Contact
Emergency Contact Phone *
Emergency Contact Phone
Please list any allergies or medical conditions in case of emergency.
I-90 Training Center Waiver
Electronic Signature *
Release of Liability
Legal Name *
Legal Name

PAYMENT METHODS

Guest Instructor Event

Please note the date you register.

Extra Banquet Guests

Extra banquet guests not participating in main event.
PayPal Acceptance Mark

Now Accepting Credit Cards

at I-90 Training Center with

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