Revised January 1, 2004

Prairie Aikikai is an organization whose primary purpose is to promote the principles and practice of the martial art of Aikido. Membership in the Prairie Aikikai is open to all interested persons regardless of an individual’s age, gender, ethnic background, sexual orientation, or any handicapping condition. Prairie Aikikai is incorporated within the State of Illinois (“Prairie Aikikai, Inc.”), and is affiliated with the Aikido Schools of Ueshiba (Mitsugi Saotome, Shihan). Dr. Jeffrey B. Hecht (Sandan) is the Prairie Aikikai Head Instructor and Dr. Leslie B. Hecht (Nidan) is the Assistant Instructor.

Prairie Aikikai typically sponsors practices several times week, affording members a number of opportunities for beginning, intermediate/advanced, and weapons Aikido instruction and practice. Members of the Prairie Aikikai also routinely engage in a number of additional activities, which have included: sponsored seminars with special guest instructors, trips to other martial arts schools for regular or special practices, public demonstrations and information sessions, and a variety of social events. NOTE: some activities may require the payment of an additional fee to cover the cost of that activity.

Prairie Aikikai members agree to pay an annual fee: $70 per year for kyu (“white belt”) ranks and $110 per year for dan (“black belt”) ranks. Members pay for practices either on a per-practice “mat fee” basis ($3 per practice), or a monthly/semester and/or family single-pay arrangement (rates vary). Members also agree to abide by appropriate codes of conduct and behavior during all practices and at all other Prairie Aikikai gatherings. Individuals who do not pay the annual fee and/or appropriate practice fees, or who – in the opinion of the Head Instructor – engage in dangerous or other inappropriate behaviors, may have their membership in the Prairie Aikikai revoked without refund.

In consideration of my acceptance as a participant practicing in the activities of the Prairie Aikikai, Inc. or as the natural or legal guardian of a minor accepted as a participant, I agree to be legally bound for myself, my heirs, executors, and administrators and hereby waive and release forever and discharge any and all rights and claims for damages which may or hereafter occur to me against: Prairie Aikikai, Inc.; Prairie Aikikai’s directors, officers and members; Head Instructor Jeffrey B. Hecht and Assistant Instructor Leslie B. Hecht; and their officers, agents, representatives, directors, assistant and guest instructors, successors and/or assigns for any and all damages which may be sustained and suffered by me in connection with my association with, during my participation, study, and practice in any activity or entry in the above program in Aikido, or which may arise out of my travel to participate in and return from such activity sponsored by said organization or individuals.

I understand that, as a participant or the legal guardian of a participant, that the practice of any martial art, including those taught during Aikido classes, requires physical contact and that all kinds of injuries, including serious injuries and even death, may occur. I recognize that I am personally assuming all of the responsibility and all of the risk of such injuries, on my own behalf and/or on behalf of my child/children/ward(s). Furthermore, I completely release and fully indemnify Prairie Aikikai, Inc.; Prairie Aikikai’s directors, officers and members; Head Instructor Jeffrey B. Hecht and Assistant Instructor Leslie B. Hecht; and their officers, agents, representatives, directors, assistant and guest instructors, successors and/or assigns for any and all liability occurring by or through my participation, or the participation of my child/children/ward(s).

It is my intention to completely release and fully indemnify from all liability the organizers and all other participants in the Prairie Aikikai to the maximum extent allowed under the public policy of the State of Illinois. If any portion of this release would be determined to be invalid as to any type of liability, it is my intention that the release and indemnification should continue and remain in effect as to any conduct, circumstances, or risks that may be properly released, indemnified, or assumed by me under the public policy of the State of Illinois.

I have read the above waiver and release and agree to its conditions:

Date: _______________
Print Name of Participant ____________________________	Signature ________________________________
Name of Parent/Guardian ____________________________	Signature ________________________________
(if participant under 18 years of age)
Print Name of Witness ____________________________	Signature ________________________________