KICKS TAEKWONDO
Release and Waiver of Liability & Indemnity Agreement
Name
*
First Name
Last Name
Email
*
example@example.com
Please Select the event you are attending at KICKS.
*
Please Select
Birthday Party
Free Trial Class
Buddy Week
Teacher Workday/Holiday Camp
Seminar/Workshop
Parents Night Out
Event Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone Number
*
-
Area Code
Phone Number
How did you hear about us? If by a member, please list referral name.
*
*Complete a SEPARATE waiver for yourself and each child.* If signing this waiver for a minor, please enter child's name and age below
Minor's name, age
Disclaimer
LIABILITY & RELEASE WAIVER
Signature
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
Should be Empty: