Moulder Martial Arts Class Registration & Waiver
Complete this form to request a regular Saturday class date and sign the required participant waiver.
Participant Full Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Parent/Guardian Full Name (if participant is a minor)
First Name
Last Name
Preferred Saturday Class Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Saturday Classes 11:15 - 12:00
Participant(18+) or Parent/Legal Guardian Email
*
example@example.com
Emergency Contact Name
First Name
Last Name
Participant(18+) or Parent/Legal Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
terms & conditions
Moulder Martial Arts Participant Waiver, Release of Liability & Assumption of Risk Participant Agreement I understand that participation in martial arts instruction, training, demonstrations, exercises, games, and related activities involves physical activity and carries inherent risks. These risks may include, but are not limited to, falls, collisions, contact with other participants, strains, sprains, bruises, fractures, and other injuries. Assumption of Risk I voluntarily choose to participate, or allow my minor child to participate, in activities provided by Moulder Martial Arts. I understand the nature of these activities and knowingly accept the ordinary and inherent risks associated with participation. Release of Liability To the fullest extent permitted by applicable law, I release and hold harmless Moulder Martial Arts LLC, its owners, instructors, employees, volunteers, and agents from claims arising from the ordinary risks inherent in participation in Moulder Martial Arts activities. This release is not intended to waive any rights or claims that cannot legally be waived under applicable law. Medical Treatment I certify that I, or my minor child, am physically able to participate in martial arts activities or have obtained appropriate medical clearance when necessary. If an injury or medical emergency occurs and I cannot be reached, I authorize Moulder Martial Arts personnel to contact emergency medical services and take reasonable steps to obtain appropriate medical assistance. I understand that I am responsible for medical expenses incurred as a result of participation except where otherwise required by law. Rules and Safety I agree that I, or my minor child, will follow reasonable safety instructions and rules provided by Moulder Martial Arts instructors. I understand that failure to follow safety instructions may result in removal from an activity or class. Parent or Guardian Consent If the participant is under 18 years old, I certify that I am the participant's parent or legal guardian or otherwise have legal authority to provide this consent. I give permission for the minor participant named on this registration to participate in Moulder Martial Arts activities and acknowledge the risks described in this agreement. Electronic Agreement By checking the agreement box and entering my full legal name below, I acknowledge that: I have read and understand this waiver. I have had an opportunity to review its terms before agreeing. I voluntarily agree to its terms. My signature below is intended to serve as my electronic signature.
I acknowledge and agree to the terms and conditions of participation in the martial arts classes.
*
I agree to the terms & conditions
Participant(18+) or Parent/Legal Guardian
*
Submit
Submit
Should be Empty: