I hereby give the following person(s) authorization to pick up my child(ren) from Black Lotus Gym's summer camp

Camp participants are expected to always exhibit appropriate behavior while at camp. All campers must understand and follow the guidelines set forth. Please review this policy and guidelines with your child as violations will result in disciplinary action and removal from camp without a refund: • Talk in a pleasant manner. Foul/Inappropriate language, putdowns, and bullying will not be accepted. • Be safe! Always obey camp rules and staff. Disruptive and disobedient behavior will not be accepted. • Treat all peers, equipment, and the studio with proper care and respect. • Show respect for the staff and fellow campers. • Aggressive behavior that is threatening to any child, staff, or the studio will not be permitted at camp and will result in immediate removal without a refund. • Have a positive attitude and have fun!

Please review the discipline procedures here. Depending on the severity of the behavior, we may skip a particular step. (I.e. aggressive behavior will not be tolerated and will result in the immediate removal of a child from camp without a refund.) 1. Verbal Warning 2. Time Out- During a time out a camper may sit out from activities including games, physical activities, board breaking or another special event. Parents will be notified of their child’s time out via email. 3. Written Warning - if a child persists in unacceptable behavior, a written warning will be issued to the Parent. The Lead Counselor will speak with the child immediately during/after the incident and then the parent/guardian upon arrival. The parent/guardian will be required to sign the written warning. ***After receiving two written warnings the child will be dropped from Camp and will not be permitted to sign up for Camp in the future. No refunds will be given. Please review these rules with your child prior to the first day of camp.

Cancel or request a change in your camp selection(s) up to 5 DAYS before the event start date. A 3% cancellation administration fee applies to any refunds (the cost of payment processing). The refund amount is based off our camp rates less the 3%. No refunds or requests to change weeks will be granted with less than 5 DAYS before the event start date. NO EXCEPTIONS. There are no pro-rates or refunds if a student does not attend.

By agreeing to his release, consent and waiver you (buyer) certify that you are at least 18 years of age as the participant or you are the parent/guardian of a minor participant under 18 years of age. READ CAREFULLY: I, being 18 or older, or the legal guardian of the above named person who is under 18, as a participant in Black Lotus Training Center, LLC. DBA Black Lotus Gym's program activities (“Program”), hereby RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE the Program, Black Lotus Training Center, LLC, and their respective employees, agents, representatives and volunteers (hereinafter referred to as “RELEASEES”) from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me and/or my child, or to any property belonging to me and/or my child, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES or otherwise, while participating in the Program, or while in, on or upon the premises where the Program is being conducted, which includes on location and off location activities. Program Activities may include, but are not limited to the following: • MARTIAL ARTS TRAINING • PARENT'S NIGHT OUT EVENTS • COMPETITIONS - BOTH ON LOCATION AND OFF LOCATION, IN STATE AND OUT OF STATE • BIRTHDAY PARTY EVENTS • SUMMER CAMP EVENTS • SELF DEFENSE EVENTS

I am fully aware of the risks and potential hazards connected with participating in the Program, including but not limited to, the risk of loss of personal property from theft, injuries associated with MARTIAL ARTS TRAINING, and other injuries that may not be foreseeable and I hereby elect to voluntarily participate or to have my minor child participate in the Program, and engage in such activity knowing that the activity may be hazardous to me and/or my child and my property. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OF LOSS, PROPERTY DAMAGE OR PERSONAL INJURY, that may be sustained by me and/or my child, or any loss or damage to property owned by me and/or my child, because of me and/or my child being engaged in such an activity, WHETHER CAUSED BY THE NEGLIGENCE OF RELEASEES or otherwise. 

I further acknowledge that I and/or my child is in good physical condition and I do not know of any medical or physical condition or other reason that I and/or my child should not participate in the Program or which could interfere with my and/or my child’s safety in such Program, or else I am willing to assume—and bear the cost of— all risks that may be created, directly or indirectly, by any such condition. My and/or my child’s participation in any Program activity is purely voluntary, and I elect to have myself and/or my child participate despite the risks and known or unknown dangers associated with Program activities.

During the Program, I hereby give permission for the Program staff to administer appropriate medical attention to myself and/or my child in the event of any accident, illness, or injury, including non-prescription medications or any medications my child brings to class, camp or other events in original containers with dosage instructions that is provided to Program staff. In the event of an emergency, 911 will be called and I will be responsible for all costs of medical coverage and treatment provided not covered by my and/or my child’s insurance.

I further hereby authorize Black Lotus Training Center, LLC DBA Black Lotus Gym to photograph and/or video record myself and/or my child during the Program, and use or distribute any picture or video related to Program activities that I and/or my child is depicted in. I also authorize use of these materials for publication in a brochure, on websites, or other promotional material and social media. They may also be distributed to other Program participants, including but not limited to a Program group picture of all participants. 

Black Lotus Training Center, LLC DBA Black Lotus Gym reserves the right to cancel any membership/trial/intro without refund for any reason, including but not limited to misconduct, rude/inappropriate behavior, disrespect, etc. from the student and/or parent, guardian or family member.

I HEREBY EXPRESSLY RECOGNIZE AND ASSUME ALL RISKS ASSOCIATED WITH MY AND/OR MY CHILD’S PARTICIPATION IN THE PROGRAM AND VOLUNTARILY RELEASE, WAIVE, DISCHARGE, COVENANT NOT TO SUE AND HOLD HARMLESS THE RELEASEES. I AGREE TO INDEMNIFY AND HOLD HARMLESS the RELEASEES from any loss, liability, damage or costs, including court costs and attorneys’ fees, that may incur due to my and/or my child’s participation in the Program WHETHER CAUSED BY THE NEGLIGENCE OF RELEASEES or otherwise. It is my express intent that this Participant Release, Consent and Waiver of Liability shall bind the members of my family and spouse, if I am alive, and my heirs, assigns and personal representative, if I am deceased, and shall be deemed as a RELEASE, WAIVER, DISCHARGE AND COVENANT NOT TO SUE the above-named RELEASEES. I hereby further agree that this Participant Release, Consent and Waiver of Liability shall be construed in accordance with the laws of the State of Florida. IN AGREEING TO THIS PARTICIPANT RELEASE, CONSENT AND WAIVER OF LIABILITY, I ACKNOWLEDGE AND REPRESENT THAT I have read the foregoing, understand it and agree voluntarily as my own free act and deed; no oral representations, statements, or inducement, apart from the foregoing written agreement, have been made; I am at least eighteen (18) years of age and fully competent and/or I am the parent or guardian of the child participant, and I agree to this Participant Release, Consent and Waiver of Liability for full, adequate and complete consideration, fully intending to be bound by same. I agree to all terms and conditions on today's date and understand that my agreement remains in effect in perpetuity. By voluntarily checking the box “I agree.." and/or signing, I warrant that I have read, or have had read to me, the entire agreement and all of the forgoing: IN FULLY RECOGNIZING THAT IF ANYONE IS HURT OR PROPERTY IS DAMAGED WHILE I AM PARTICIPATING IN BLACK LOTUS TRAINING CENTER, LLC DBA BLACK LOTUS GYM, I WILL HAVE NO RIGHT TO MAKE A CLAIM AND FILE A LAWSUIT AGAINST BLACK LOTUS TRAINING CENTER, LLC DBA BLACK LOTUS GYM, ITS OFFICERS, AGENTS, LICENSED AFFILIATES, OR EMPLOYEES EVEN IF THEY OR ANY OF THEM NEGLIGENTLY CAUSED THE BODILY HURT OR PROPERTY DAMAGE and further agree that no oral representations, statements, or inducements, apart from the foregoing written agreement have been made. THE NAMED PARTICIPANT AND/OR THEIR LEGAL GUARDIAN authorizes Black Lotus Training Center, LLC DBA Black Lotus Gym to use, reproduce, and or publish all written and/or visual materials that may pertain to me. I understand that this material may be used in various publications, public affairs releases, marketing material, or for other related endeavors. I understand that by checking the box "I Agree..." and/or signing, I agree to opt in and subscribe to receive emails from Black Lotus Training Center, LLC DBA Black Lotus Gym until I unsubscribe.

If you are paying for your child’s program using an EMA (PEP) scholarship: 1. Please select your desired registration and program/semester options. 2. Enter “PEP” in the coupon code box at checkout and proceed to submit your registration. 3. In your EMA portal, please search Black Lotus Gym and reserve your funds through your EMA portal for the selected registration & program amount. Your child’s spot in the program will only be confirmed once we receive notification that your funds have been reserved. If funds are not reserved in a timely manner, your registration may be released to another family. (If you have any questions about this process, please contact us at 561-740-6018 before completing your registration.)