2025 Registration & Waiver Form

2025 Registration & Waiver Form
Student Information:
Student Name:

First NameLast Name
Date of Birth:

MonthDayYear
Age
Does your child have any Special Needs? If so, please explain:
Does your child have any Medical or Health Concerns? If so, please explain:
Parental Information:
Parent(s) / Legal Guardian(s)

First NameLast Name
Parent(s) / Legal Guardian(s)

First NameLast Name
Address, City, State, Zip
Phone/Alt Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Primary Email:
example@example.com
Who will be responsible for picking up your child?
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
In case of an Emergency, and Parent cannot be reached, please notify:
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Signature
Date

MonthDayYear
Date
**All adults that are interested in the parent helper program MUST provide a background check to Triad Hapkido LLC prior to registration and participation.

WAIVER AND RELEASE OF LIABILITY
In consideration of the risk of injury while participating in Martial Arts (the “Activity”), and as consideration for the right to participate in the Activity, Parent/Legal Guardian of the Student knowingly and voluntarily enter into this waiver and release of liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of the students participation in the Activity, and do hereby release and forever discharge Triad Hapkido LLC, and their affiliates, instructors, members, staff, volunteers, for any physical injury that may occur before, during or after participation in the Self Defense class.
I agree to indemnify and hold harmless Triad Hapkido LLC against all claims, suits, or actions of any kind whatsoever for liability, damages, and lost/stolen items.
While steps are taken to prevent injury, accidents can happen. If participants should require medical care or treatment, they agree to be financially responsible for any cost incurred because of such treatment.
If any damage to equipment or facilities occurs, I acknowledge and agree to be held liable for all costs associated.
I, the undersigned Parent/Legal Guardian does not hold Triad Hapkido LLC and staff members liable for the safety and well being of any child that is left outside of the classroom unattended.
I, the undersigned Parent/Legal Guardian of the student, affirm that I am of the age of 18 years or older, and that I am freely signing this agreement. I certify that I have read this agreement, that I fully understand its content and that this release cannot be modified orally. I am aware that this is a release of liability and a contract and that I am signing it of my own free will.
Parent/Legal Guardian Signature:
Print Name:
Date

MonthDayYear
Photo Release Waiver for Minors under the age of 18:

I give my permission to use my child's photograph publicly to promote Triad Hapkido LLC. I understand that the images may be used in print publications, online publications, presentations, websites including social media sites. I also understand that no royalty, fee, or other compensation shall become payable to me by reason of such use.
Do you give permission:
Parent/Legal Guardian Signature:
Date

MonthDayYear
Photo Release Waiver for Adults over the age of 18:

I give my permission to use my own personal photograph publicly to promote Triad Hapkido LLC. I understand that the images may be used in print publications, online publications, presentations, websites including social media sites. I also understand that no royalty, fee, or other compensation shall become payable to me by reason of such use.
Do you give permission:
Parent/Legal Guardian Signature:
Date

MonthDayYear
Should be Empty:

2025 Registration & Waiver Form

Student Information:

Parental Information:

Who will be responsible for picking up your child?

In case of an Emergency, and Parent cannot be reached, please notify:

**All adults that are interested in the parent helper program MUST provide a background check to Triad Hapkido LLC prior to registration and participation.

WAIVER AND RELEASE OF LIABILITY