HAWAII JUDO ACADEMY Building Champions for Success at All Levels in Life

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1 10AM 11AM CLASS SCHEDULE Monday Tuesday Wednesday Thursday Friday Saturday Training (Kids &Adult) 10:00-12:00) 12AM 1 PM 4PM Kids Intro 4:30-5:00 5 PM Kids Kids 1 5:00-7:00 5:00-6:10 6 PM Kids 2 6:15-7:25 Kids Intro 4:30-5:00 Kids 5:00-6:10 Kids 5:00-7:00 Kids Intro 5:45-6:15 Kids 1 6:15-7:25 7 PM 8 PM Advanced/ 7:00-9:00 Advanced/ 7:00-9:00 CLASS DESCRIPTIONS Kid Intro No prior judo experience, Ages 4+ An introductory class to judo teaching proper dojo etiquette (sitting, bowing, etc.); proper belt tying; safety awareness and techniques and other fundamental judo skills. Kids 1 White, Yellow Belts, Ages 5+ Kids 2 Yellow, Orange, Blue Ages 6-11 Teen/ Adult White, Blue, Purple Belts, Ages 12 and Above Teen/ Adult Advanced/ Ages 12 and Above * All Ages; *Must meet competition

2 STUDENT INFORMATION: HAWAII JUDO ACADEMY requirements and be authorized by Instructor ENROLLMENT FORM Name: DOB: School: Sex: M or F Name of Guardians/Parents: Address: Phone: Cell: _ Medical Conditions (previous physical injuries, learning disabilities, medications, etc.): Previous Experiences (list any prior experiences with judo, wrestling or any other martial arts): EMERGENCY CONTACT INFORMATION (if different than above): Emergency Contact: _ Relationship: Phone Number: (Home) (Cell-phone) Medical Insurance Carrier: Preferred Honolulu Hospital: Please List Class(es) Enrolling In: Questionnaire: How did you hear about us? If a referral, who referred you? What are your goals (or goals for your child) in attending judo?

3 Please read CAREFULLY before Signing. In consideration of being permitted to participate in any way in the Martial Arts Program indicated below and/or being permitted to enter for any purpose any restricted area (here in defined as any area where in admittance to the general public is prohibited), the parent(s) and/or legal guardian(s) of the minor participant named below agree: (1) The parent(s) and/or legal guardian(s) will instruct the minor participant that prior to participating in the below martial arts activity or event, he or she should inspect the facilities and equipment to be used, and if he or she believes anything is unsafe, the participant should immediately advise the officials of such condition and refuse to participate. I understand and agree that, if at any time, I feel anything to be UNSAFE, I will immediately take all precautions to avoid the unsafe area and REFUSE TO PARTICIPATE further. (2) I/WE fully understand and acknowledge that: (a) There are risk and dangers associated with participation in martial arts events and activities which could result in bodily injury partial and/or total disability, paralysis and death. (b) The social and economic losses and/or damages, which could result from these risks and dangers described above, could be severe. (c) These risks and dangers may e caused by the action, inaction or negligence of the participant or the action, inaction or negligence of others, including, but not limited to, the Releasees named below. (d) There may be other risks not known to us or are not reasonably foreseeable at this time. (3) I/WE accept and assume such risks and responsibility for the losses and/or damages following such injury, disability, paralysis or death, however caused and whether caused in whole or in party by the negligence of the Releasees named below. (4) I/WE HEREBY RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE the martial arts school and facility used by the participant, including its owners, managers, promoters, lessees of premises used to conduct the martial arts event or program, premises and rent inspectors, underwriters, consultants and others who give recommendations, directions or instructions to engage in risk evaluation or loss control activities regarding the martial arts facility or events held at such facility and each of them, their directors, officers, agents, employees, all for the purposes herein referred to as Releasee FROM ALL LIABILITY TO THE UNDERSIGNED, my/our personal representatives, assigns, executors, heirs and next to kin FOR ANY AND ALL CLAIMS, DEMANDS, LOSSES OR DAMAGES AND ANY CLAIMS OR DEMANDS THEREFORE ON ACCOUNT OF ANY INJURY, INCLUDING BUT NOT LIMITED TO THE DEATH OF THE PARTICIPANT OR DAMAGE TO PROPERTY, ARISING OUT OF OR RLEATING TO THE EVENT(S) CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PARTY BY THE NEGLIGENCE OF THE RELEASEE OR OTHERWISE. (5) I/WE HEREBY acknowledge that THE ACTIVITIES OF THE EVENT(S) ARE VERY DANGEROUS and involve the risk of serious injury and/or death and/or property damage. Each of THE UNDERSIGNED also expressly acknowledge that INJURIES RECEIVED MAY BE COMPOUNDED OR INCREASED BY NEGLIGENT RESCUE OPERATIONS OR PROCEDURES OF THE RELEASEES. (6) EACH OF THE UNDERSIGNED further expressly agrees that the foregoing release, waiver, and indemnity agreement is intended to be as broad and inclusive as is permitted by the law of the State of Hawaii or the State in which the event is conducted and that if any portion is held invalid, it is agreed that the balance shall, notwithstanding continue in full legal force and effect. (7) On behalf of the participant and individually, the undersigned partner(s) and/or legal guardian(s) for the minor participant executes this Waiver and Release. If, despite the release, the participant makes a claim against any of the Releases, the parent(s) and/or legal guardian(s) will reimburse the Release the Releasee for any money which they have paid to the participant, or on his behalf, and hold them harmless. I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF THE RISK AND INDEMNITY AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW. Participant Signature (Parent/Guardian if Minor): Printed Name of Parent or Guardian (if minor): Printed Name of Participant: Address of Participant: Date: Phone Number:

4 Dear Students & Parents, HAWAII JUDO ACADEMY Tuition Payment Policy Hawaii Judo Academy (HJA) will be collecting tuition payments through an electronic payment system via the Automated Clearing House (ACH). An ACH payment is an electronic payment that allows you to select a designated bank account to pay for your monthly tuitions. ACH is reliable, safe and convenient. It also allows us to be more efficient with collection tuition so that we can save you from incurring additional fees. Please review and sign that you have read the payment policy stated below. 1) Monthly Tuitions are due by the 5 th day of each month in form of the electronic payment (ACH). 2) ACH payment Payment will be processed on the 5 th day of each month or the following business day if the 5 th lands on a weekend or holiday. No set-up fee or transaction fee $25 Fee for insufficient funds or any bank rejection notice Available to terminate by giving a (1) month WRITTEN notice. PAYMENTS WILL NOT BE STOPPED UNLESS WRITTEN NOTICE IS SUBMITTED. (Note: Tuitions will not be pro-rated if you terminate in the middle of the month. The current month and the next month s tuition will still be withdrawn (i.e. If you terminate between July 5-31, tuition will still be taken out for the month of July and August). HJA will not place any holds on student payments. If you would like to discontinue any payments for a period of time, you will need to resubmit ACH form and you will be subject to new tuition rates. Student Name: Parent s Name if Minor: Signature of Student or Parent if Minor: Date:

5 AUTHORIZATION AGREEMENT FOR PREAUTHORIZED PAYMENTS (ACH DEBITS) NAME: ADDRESS: PHONE NUMBER: NOTE: Due to the time required for company and bank processing, please allow one or two weeks for processing. I (we) hereby authorize HAWAII JUDO ACADEMY, hereinafter called COMPANY, to initiate debit entries and to initiate, if necessary credit entries and adjustments for any debit entries in error to my (our) account indicated below and the depository financial institution named below, hereinafter called DEPOSITORY, to debit and/or credit the same to such account. DEPOSITORY FINANCIAL INSTITUTION BRANCH CITY STATE ZIP CODE TRANSIT ROUTING NUMBERS : : ACCOUNT NUMBER INFORMATION This authority is to remain in full force and effect until COMPANY has received written notification from me (or either of us) of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it. Please attach a voided check for account validation. NAME (S) PLEASE PRINT ADDRESS CITY/STATE ZIP CODE SIGNED DATE

6 Take Care of Yourself Be On Time Dress with Appropriate Attire No Horseplay No Foul Language Have Good Hygiene Don t Wear Jewelry During Practice Keep Your Toenails and Fingernails Short No Gum Chewing Take Care of This Place Please Help Keep The Dojo Clean Put Trash in Proper Receptacles Store Personal Equipment Neatly Be Courteous with Restroom Use Take Care of Equipment No Shoes or Slippers in the Training Area Take Care of Others Respect and Be Courteous to Other Students and Instructors