Hwa Sun Martial Arts Student Waiver
1. Student Name
*
First Name
Last Name
Birthdate:
*
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Month
-
Day
Year
Date
2. Student Name
First Name
Last Name
Birthdate:
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail:
*
example@example.com
Tel:
*
Parent 1 /Guardian 1 Name:
*
First Name
Last Name
E-mail:
*
example@example.com
Tel:
*
Parent 2 /Guardian 2 Name:
*
First Name
Last Name
E-mail:
*
example@example.com
Tel:
Additional Emergency Contact other than parent:
*
First Name
Last Name
Relation:
Number
*
Photo and Video Release:
Hwa Sun Martial Arts, LLC and those working under their direction are hereby granted permission to take photographs and videos of me and my minor student and use in brochures, websites, posters, advertisements, and other promotional materials Hwa Sun Martial Arts, LLC creates. I also acknowledge that Hwa Sun Martial Arts may have video surveillance on premises.
*
Approve
Signature - Must age 18 or older to sign:
*
PLEASE READ AND SIGN WAIVER
WAIVER AND RELEASE OF LIABILITY: Hwa Sun Martial Arts, LLC encourages you and all students to obtain a physical examination from a doctor before using any exercise equipment or participating in any exercise classes. All exercises including the use of weights and use of any and all equipment and apparatus designed for exercising shall be at the student’s sole risk. In consideration for the attendance and participation in the martial arts training offered by Hwa Sun Martial Arts, I, the student/parent or guardian, acknowledge the existence of certain inherent risks in this type of training and hereby agree to assume all risks. I further relieve the school, its services and management, assigned staff and fellow students from any liability resulting from loss, whether personal belonging or bodily injury. Hwa Sun Martial Arts LLC shall not be liable to student for any claims, demands, injuries, damages, or actions arising due to injury to student’s person or property arising out of or in connection with the use by student of the services, facilities, and premises of Hwa Sun Martial Arts LLC. Student hereby holds Hwa Sun Martial Arts LLC, its officers, owners and employees harmless from all claims which may be brought against them by student or on student’s behalf for any such injuries or claims. I also hereby state that I or my child is physically fit to take the prescribed course of instruction and do so of my own free will in exchange for agreed upon fee. I understand there is no refund policy on any money I pay to Hwa Sun Martial Arts.
RELEASE OF LIABILITY
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Approve
Date:
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Month
-
Day
Year
Date
Signature - Must be age 18 or older to sign:
*
Please verify that you are human
*
Submit
Should be Empty: