JiriKM & JEP Waiver

JiriKM & JEP Waiver
School*
JiriKM Program*
JEP Program*
Student's Name*

First NameLast Name
Guardian's Name (if applicable)

First NameLast Name
Date of Birth*

DayMonthYear
Gender*
Phone Number*

Area CodePhone Number
Email*
Address*

Street Address

Street Address Line 2

CityState / Province / Region

Postal / Zip CodeCountry
In consideration for my or my child's attendance and participation in the martial arts training offered by JiriKM and Jiri Entertainment Productions, I acknowledge the existence of certain inherent risks in this type of training and hereby agree to assume all risks. I further relieve Jiri Entertainment Productions LLC, the school, it's management, assigned staff, and fellow students from liability resulting from bodily injury, virus, any type of contagious sickness, or loss, whether personal belongings or bodily injury. I understand that member images may be used for promotional or training purposes. I agree that I or my child will not attend any event at any time when I or my child believes that they might be ill, is experiencing any symptoms of illness, or has been exposed to a person or persons known to be infected with a contagious illness. I also hereby state that I or my child is physically fit to take the prescribed course of instruction and does so of my own free will.
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