Adult Waiver



For and in consideration of permitting the Participant (full name)
to use the facilities and participate in the programs and events (the “Programs”) at Ray Thompson’s Upstate Karate, LLC (“Upstate Karate”), the Participant hereby understands and agrees to the following for the entire duration of his/her participation in the Programs:
(i) The Programs involve certain inherent risks. Certain risks cannot be eliminated without eroding the unique character of the experience, and the Participant understands that Upstate Karate is not insuring against or promising to eliminate all risks. Participant recognizes and understands that martial arts training is an activity that involves physical contact and that participation in the Programs might result in serious injury, including permanent disability or even death, and severe social and economic loss. Risks involved in the Programs include, but are not limited to, concussions, cuts, bruises, and lacerations from striking and grappling, bruising and abrasions to the face, neck, or extremities, sprains, strains, fractures, or joint dislocations, negligence of staff and other participants, use of equipment, and other serious injury or death.

(ii) Participant’s participation in the Programs is purely voluntary. No one is forcing or requiring Participant to participate, and Participant elects to participate in spite of the risks. Participant understands Participant’s safety is his/her personal responsibility and Participant will notify Upstate Karate if Participant feels something is unsafe or beyond Participant’s abilities.

(iii) Participant acknowledges and understands that Participant has the opportunity to inspect Upstate Karate’s equipment and location before Participant’s participation in any Programs.

(iv) Participant certifies that Participant is not aware of any physical or mental condition that precludes Participant from participating in the Programs and that Participant is not participating against medical advice. Participant understands that Upstate Karate strongly recommends that Participant does not partake in the Programs if Participant is pregnant and advises Participant to seek medical advice before choosing to participate if Participant is pregnant.
(v) Participant agrees that Participant will comply with all of Upstate Karate’s rules and rules of the Programs. Participant understands that compliance with these rules, exercising common sense, and being aware of Participant’s surroundings can minimize Participant’s risk of injury.

(vi) Participant agrees that he/she must wear protective equipment in order to participate in any Programs involving physical contact with others. Protective equipment includes headgear, forearm pads, mouthpiece, padded gloves and boots, shin pads, and (for males) a groin protector. Participant expressly acknowledges and agrees that he/she is responsible for ensuring that his/her protective equipment is in good condition and fits correctly. Participant agrees he/she will notify Upstate Karate if Participant is unsure about how to correctly put on or adjust protective gear. Participant further expressly acknowledges and agrees that Upstate Karate may prohibit Participant from participating in any Programs if Upstate Karate, including its owners, affiliates, operators, employees, volunteers, agents, and officers, determines in its sole discretion that Participant’s protective equipment is not adequate.

(vii) 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. Upstate Karate has put in place preventative measures to reduce the spread of COVID-19; however, Upstate Karate cannot guarantee that Participant will not become exposed to or infected with COVID-19. Further, participating in the Programs could increase Participant’s risk of contracting COVID-19. Participant’s risk of becoming exposed to or infected by COVID-19 by participating in the Programs may result from the actions, omissions, or negligence of the Participant him/herself and others, including, but not limited to, Upstate Karate employees, volunteers, and participants in the Programs and their families.

(viii) Participant assumes full responsibility for all risks associated with the Programs, and for all injuries, harms, and damages that may result from participation in the Programs, including bodily injury, emotional damage, illness, disability, exposure to or contraction of COVID-19 or other pandemic disease, death and/or loss of or damage to personal property. Participant assumes responsibility for all such risks, whether identified in this document or not.

(ix) Participant grants Upstate Karate, its representatives, and its employees the right to take photographs and videos of Participant in connection with Participant's participation in the Programs. Participant hereby authorizes Upstate Karate to copyright, use, and publish the same in print and/or electronically; and hereby agrees that Upstate Karate may use such photographs and video of Participant for any lawful purpose, including but not limited to publicity, illustration, advertising, and Web content.

Release and Indemnification

By entering into this Agreement, Participant does hereby voluntarily agree to release Upstate Karate and the other parties identified below from any claims Participant might have against them arising out of any injury or loss that Participant might suffer in connection with Participant’s participation in the Programs. Participant does hereby voluntarily agree to indemnify Upstate Karate and the other parties identified below for any claims asserted against them arising out of Participant’s participation in the Programs for the entire duration of Participant’s participation in the Programs.

In particular Participant, for his/herself, his/her heirs, personal representatives, and assigns, hereby voluntarily and forever releases, waives all claims against, and discharges Upstate Karate and its owners, affiliates, operators, employees, volunteers, agents, and officers, including Shihan Properties, L.L.C., and all other persons or entities acting under the direction and control of any of the foregoing (collectively “the Released Parties”) from, and agrees not to pursue, any and all claims, demands, or causes of action, related to illness (including but not limited to COVID-19 and other pandemic diseases), injury, disability, death, property damage or any other loss which is in any way connected to Participant’s participation in the Programs. Participant further agrees to defend, hold harmless, and indemnify (including without limitation paying or reimbursing all sums they are required to pay, including attorney’s fees and costs) the Released Parties for any and all claims by Participant, Participant’s Parent or Legal Guardian, any other parent or guardian of Participant, any member of Participant’s immediate family, a rescuer, another participant, a medical care provider, or any other person, arising in whole or in part from illness, injury, disability, death, or any other loss suffered by Participant or caused by Participant in connection with Participant’s participation in the Programs.

These release and indemnity agreements are to be construed to provide release and indemnity to the fullest extent permitted by law. The release and indemnity agreements apply to claims that a Released Party was in whole or in part negligent. But, the release and indemnity agreements do not apply to any Released Party to the extent the Released Party is determined to be grossly negligent or to have caused harm intentionally.

I acknowledge that I have read and understand the foregoing and have been fully and completely advised of the potential dangers incidental to engaging in the Programs, and am fully aware of the legal consequences of signing this instrument.

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122 Blakely Rd Simpsonville, SC 29680


FRIDAY: 11 AM - 7 PM