Raise Leaders I Movie Night

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Parent/Guardian Name* This field is required.
First Name
Last Name
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Emergency Contact* This field is required.
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Guest Information* This field is required.
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Participation: I give permission for my child to participate in Raise Leaders Martial Arts Movie Night on February, 13th 2026.

Medical Treatment: I hereby give permission for my child to be given CPR and first aid treatment by a qualified staff member of the RLMA, LLC (Raise Leaders Martial Arts) staff. In the event I cannot be contacted, I also give permission for my child to be transported by ambulance or aid car to an emergency center for treatment. I further consent to the disclosure of health information and to the medical, surgical and hospital care treatment and procedures to be performed for my child by a licensed physician or hospital selected by the RLMA, LLC (Raise Leaders Martial Arts) director when deemed immediately necessary or advisable by the physician to safeguard my child’s health.

Property Loss: I understand that RLMA, LLC (Raise Leaders Martial Arts) is not responsible for personal property lost, damaged or stolen while participating in our aftercare and camp programs and activities.

Insurance: I understand it is my responsibility to provide for my child’s accident and health coverage while participating in these programs and I further understand that Raise Leaders does not provide this coverage.

Release from Liability and Indemnification: Recognizing that RLMA, LLC (Raise Leaders Martial Arts) will do its best to ensure a safe experience, I understand that accidents may occur both from my child’s participation in program activities and from transportation to and from the program. I agree to assume these risks. By signing below, I release RLMA, LLC (Raise Leaders Martial Arts) , its owners, employees, volunteers, independent contractors, directors and agents from all liability based on any damage, loss, injury or death whether it is the result of ordinary negligence or otherwise, caused to my child or to me from participation in RLMA, LLC (Raise Leaders Martial Arts) programs. I further agree to indemnify and hold RLMA, LLC (Raise Leaders Martial Arts) harmless from all claims that are in any way connected with my child’s participation in this program.

PERMISSION is given to RLMA, LLC to use photographs of myself/child (regarding after-care, martial arts and camp) in promotional material.
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I have read and understand the above and have completed this form to the best of my ability.* This field is required.
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Payment* This field is required.
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Raise Leaders Movie Night
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