Enrollement form and waiver of liability

Student full name {name}  ________________________________  Date of Birth {dob}__________

Address {address} ________________________,________________, MI.  ____________

Phone # {phone} (______) ______________________

Emergency contact  name {contact_name}  ________________________________

Emergency contact Phone {contact_phone} _________________________________

Emergency contact relation {contact_relation}  ______________________

Email address: ___________________________@ __________________________

Reason for interst in martial arts__________________________________________________

Please list experiece/ranks: _____________________________________________________

Do yo have any physical or mental issues that could prevent/limit you from training? _______

If YES, please explain ____________________________________________________________

_{I understand that any martial art or physical fitness program has the potential to be harmful. I attest that I am in good health and able to take part in the class with no physical or mental restrictions. I do not hold liable the instructors, fellow students, guests, visiting instructors, township, or anyone else associated with the program, any claim for damage I may have from participation in this/these classes.  _________.} 

_{I understand the martial arts development is physical, mental, and emotional.  Spirituality is not tuaght but sometimes occurs. To be able to to progress, much attention should be placed on students attendance and participation.  We expect students to be at their scheduled classes on a very regular basis.  Missing 2 or more classes in a month can negatively impact a students ability to learn and advance in a timely manner.  We strive for perfect attendance! _________{initial}.}

_{We often take pictures and occassionally videos of classes and students.  I waive any claim of ownership of images and pictures, and furthermore, allow use of said likenesses and images in future marketing, and promotional material.  ________{initial}}

Signature_________________________________ Date {sign_date}___________

Parent or Guardian Signature __________________________ {sign_date} __________