BUS SYSTEM YOUTH Registration Form

How did you hear about us?*

Date*

Date

Athlete Information

Name*

First NameLast Name

Date Of Birth*

Date

Age*

Child must be age 5-12 for kids program.

MaleFemale

YesNo

If yes, please describe.

BeginnerCurrent StudentAdvanced

Please provide details of previous martial arts experience.

Select SHIRT size.*

Select PANT size.*

YesNo

Additional Student Name*

First NameLast Name

Date of Birth*

Date

Age*

MaleFemale

YesNo

If yes, please describe.

BeginnerCurrent StudentAdvanced

Please provide details of previous martial arts experience.

Select SHIRT size.*

Select PANT size.*

Parent/Guardian Information (if athlete is under 18)

Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact List (Must have at least 1 emergency contact other than enrolling parent).

Name*

First Name Last Name

Mobile Number*

Area CodePhone Number

Name

First Name Last Name

Mobile Number

Area CodePhone Number

Monthly Self-Defense Lessons- First month is $350, then $250 per month for 1 child. Includes two practice t-shirts and draw string bag.Weekly Self-Defense Lessons- includes 3 classes a week for 1 child at $75. Registration Fee of $75.Monthly Hybrid Lessons- For families interested in the convenience of a mixture of online and in-person lessons. Rate provided at invoice.Invoice for family of 2 or more at monthly rate.

LIABILITY WAIVER & ASSUMPTION OF RISK AGREEMENT
The Bancroft Urban Survival System, LLC
Georgia

1. ACKNOWLEDGMENT OF RISK
I understand that participation in martial arts, self-defense training, executive protection training, fitness conditioning, sparring, drills, weapons training (training replicas only), and related activities involves inherent risks, including but not limited to:

Physical contact
Striking, grappling, joint locks
Falls or collisions
Muscle strains or sprains
Cuts, bruises, fractures
Serious bodily injury or death
I voluntarily choose to participate with full knowledge of these risks.

2. ASSUMPTION OF RISK
I knowingly and voluntarily assume all risks, known and unknown, associated with participation in activities conducted by:

The Bancroft Urban Survival System, LLC,
its owners, managers, instructors, employees, contractors, volunteers, and affiliates (collectively, “Released Parties”).

3. RELEASE OF LIABILITY (GEORGIA)
To the fullest extent permitted by Georgia law, I hereby release, waive, discharge, and covenant not to sue the Released Parties from any and all claims, demands, causes of action, damages, or liabilities arising out of or related to participation, including those resulting from ordinary negligence.

This release applies to:

Personal injury
Property damage
Emotional distress
Medical expenses
Any loss arising from participation

4. INDEMNIFICATION
I agree to indemnify and hold harmless the Released Parties from any claim brought by or on behalf of me, my child, or any third party arising from participation.

In the event of injury or medical emergency, I authorize The BUS System Academy staff to seek emergency medical treatment on my behalf.

I understand I am financially responsible for all medical costs.

5. SAFETY RULES COMPLIANCE
I agree to:

Follow all instructor directions
Use required protective equipment
Refrain from unsafe or reckless behavior
Immediately report injuries
Failure to comply may result in suspension or termination without refund.

6. NO GUARANTEE OF RESULTS
I understand that no specific training outcome, rank advancement, or physical result is guaranteed.

7. SEVERABILITY
If any portion of this Agreement is deemed unenforceable, the remaining provisions shall remain in full force and effect.

8. GOVERNING LAW & VENUE
This Agreement shall be governed by the laws of the State of Georgia, with venue exclusively in Georgia courts.

9. ACKNOWLEDGMENT & SIGNATURE
I HAVE READ THIS AGREEMENT IN FULL AND UNDERSTAND THAT I AM GIVING UP LEGAL RIGHTS BY SIGNING IT.

LIABILTIY WAIVER AND ASSUMPTION OF RISKS AGREEMENT Acknowledgement Initials*

Media Waiver Acknowledgement

From time to time, The BUS System, LLC will post photographs of our athletes, coaches, and supporters online. I will let The BUS System know by email if I do not consent to my or my child’s photos being shared.

Media Acknowledgement Initials*

Medical Authorization

In the event of an injury or medical emergency, I allow The BUS System to provide first aid, arrange transport to a medical facility, and authorise emergency treatment as recommended by a doctor for the athlete named above.

I understand that all reasonable efforts will be made to contact the athlete’s parent and/or emergency contact if an injury or medical emergency occurs.

Medical Acknowledgement Initials*

By signing below, I comfirm that the information provided is accurate and I understand and agree to the terms of this registration.

Signature*

After submission of this form, we will be in contact via the email provided to complete registration and finalize payment.

The Bancroft Urban Survival System YOUTH REGISTRATION FORM

Additional Students

MEMBERSHIPS & PAYMENTS

WAIVER ACKNOWLEDGEMENT