Nanka Individual Membership Application and Waiver FormNanka Individual Membership Application and Waiver Form If you have any Membership queries please email us at membership@nankajudo.com to contact us. Personal InformationNanka Judo Yudanshakai protects all personal information and does not share it with any third party.Name * Name First Name First Name Middle Name Middle Name Last Name Last NameAddress * Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Address Phone * Email * Date of Birth * Age (on date of application) * Gender * FemaleMaleDo not wish to disclose If Applicant is under 18 years of age, Please provide Parent/ Legal Guardian Information:Parent/ Guardian Name Parent/ Guardian Name First Name First Name Last Name Last Name Relationship Parent/ Guardian Email Parent/ Guardian Phone Parent/ Guardian Address Parent/ Guardian Address Parent/ Guardian Address Parent/ Guardian Address City City State/Province State/Province Zip/Postal Zip/Postal Parent/ Guardian Address NGB MembershipNANKA requires its members to be a member of one (or more) of the Judo National Governing Body (USJF, USA Judo or USJA). Please enter Membership Number and Date of Expiration. If you have membership in more than one of the organizations, please include your membership information for all memberships. USJF Membership ID USJF Membership Expiration Date USA Judo Membership ID USA Judo Membership Expiry Date USJA Membership ID USJA Membership Expiry Date Club/Dojo you belong to: My Current Judo Rank * NoneJunior YellowJunior OrangeJunior GreenJunior BlueJunior PurpleJunior BrownAdult Jukyu (10th Kyu)Adult Kukyu (9th Kyu)Adult Hachikyu (8th Kyu)Adult Sichikyu (7th Kyu)Adult Rokukyu (6th Kyu)Adult Gokyu (5th Kyu)Adult Yonkyu (4th Kyu)Adult Sankyu (3rd Kyu)Adult Nikyu (2nd Kyu)Adult Ikkyu (1st Kyu)Shodan (1st Dan)Nidan (2nd Dan)Sandan (3rd Dan)Yodan (4th Dan)Godan (5th Dan)Rokudan (6th Dan)Sichidan (7th Dan)Hachidan (8th Dan)Kudan (9th Dan)Judan (10th Dan) Nanka Judo Yudanshakai Waiver and Release Agreement I, the undersigned, hereby affirm that I am 18 years of age or older. In consideration of being granted permission to participate in activities organized by Nanka Judo Yudanshakai (“Nanka”), I acknowledge and agree to the following terms:Release of Liability: I release, waive, and discharge Nanka from any and all claims, demands, and causes of action, including those arising from the negligence of Nanka, related to my membership and participation in Nanka activities. This includes any actions or inactions taken by Nanka.Scope of Release: I hereby waive, release, and forever discharge Nanka, its clubs, event sponsors, staff, administrators, officials, officers, volunteers, and any other individuals or entities involved in events (collectively referred to as the "Released Parties") from any claims, damages, losses (both economic and non-economic), and liabilities of any kind (collectively "Claims"). This includes, but is not limited to, claims for death, personal injury, or property damage that may arise from my participation in or travel to and from any Nanka sanctioned event.Acknowledgment of Risks: I understand that my participation may involve risks, including but not limited to theft, damage to equipment, negligence, partial or permanent disability, and claims related to medical care or treatment. I acknowledge that these risks may be exacerbated by the negligence of the Released Parties.Indemnification: I agree to indemnify and hold harmless the Released Parties from any expenses incurred, claims made, or liabilities assessed against them, including attorney’s fees and litigation expenses, arising from my breach of this Waiver and Release Agreement, my failure to adhere to Nanka's rules, or my actions that cause injury or damage to others.No Legal Action: I agree not to sue any of the Released Parties for any claims that I have waived, released, or discharged in this agreement.Acknowledgment and Assumption of Risk in Judo Participation:I further acknowledge that participating in the sport of Judo involves inherent risks, including the potential for serious injury or even death. I understand that it is my responsibility to assess my own physical fitness and health status to ensure that I can safely engage in Judo activities. I hereby certify that I am, or will be, in adequate physical condition and sufficiently trained to participate in any events I choose to enter.I affirm that I do not have any physical or medical conditions that could pose a risk to myself or others during my participation, nor will such conditions hinder my ability to participate safely. I accept full responsibility for the condition and suitability of the facility where the event is held, as well as for the adequacy of my equipment and apparel used during my participation. By acknowledging these risks, I voluntarily assume all associated risks and waive my legal right to pursue any claims for injuries or damages that may arise from my participation in the event, including potential exposure to infectious diseases. I further recognize that any injuries or damages sustained may result from the negligence, omission, or carelessness of the event organizers or other parties involved.As an individual aged 18 years or older, I acknowledge my responsibility to familiarize myself with the policies and requirements set forth by SafeSport.I hereby grant permission to be filmed and photographed in accordance with the guidelines established by Nanka. This includes the use of my name, photographs, portraits, and motion pictures, as well as television recordings of my judo performances and participation. I also grant Nanka the rights to record and utilize these materials as deemed appropriate.I understand that this agreement is being relied upon by Nanka and its affiliates, and I voluntarily sign this Waiver and Release Agreement, acknowledging that I have read and understood its contents.This waiver is intended to protect both the Applicant and Nanka Judo Yudanshakai, ensuring a safe and enjoyable experience for all participants.Signature I have read and understand the Nanka Membership Waiver as presented above and agree to be bound by it. Applicant Signature * signature keyboard Clear To be signed if applicant is 18 years of age or olderNanka Judo Yudanshakai Parent/Legal Guardian Consent and SignatureI, as the parent or legal guardian of the Applicant), who is a minor, hereby acknowledge that I have read this agreement in its entirety and fully understand its terms and conditions.I agree to indemnify and hold harmless Nanka, its officers, directors, employees, and agents from any expenses incurred, claims made, or liabilities assessed against them as a result of any injury, death, or insufficiency of legal capacity that may arise during the Applicant's participation in activities associated with Nanka.I hereby consent to the Applicant becoming a member of Nanka and participating in Judo practices, clinics, and events sponsored by Nanka.By signing this document, I acknowledge that I have given up substantial rights and intend for this Waiver and Release to serve as a complete and unconditional release of all liability to the greatest extent permitted by law. Parent/Legal Guardian Signature signature keyboard Clear To be signed by the parent or Legal Guardian if the applicant is under the age of 18 years oldMembershipApplication Type * This is a new application Membership RenewalIndicate whether you are renewing your previous years membership or initiating a new membership.Membership Type * Non-USJF Member- Regular (18+ year of age AND Rank 1st Kyu and higher - $17.50 USJF Member- Regular (18+ year of age AND Rank 1st Kyu and higher Non- USJF Member- Associate (17 yearsof age and under OR rank is 2nd Kyu or lower) USJF Member- Associate (17 yearsof age and under OR rank is 2nd Kyu or lower) STAR Discount Card- Membership is RequiredMembership Type Quantity Total Nanka Membership Fees are included in the fees collected for USJF Membership. If you are a USJF Member and would like to purchase a Star Discount Card- Select the USJF Membership Type and the Star Discount Card. 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