Evening Martial Arts Program Registration Form

Tae Kwon Do Class
Registration Information

All Information is Confidential
1. Student's Name: *

First Name Last Name
Birth Date: *

Month Day Year
Grade:
Gender: *

Male Female
2. Student's Name:

First Name Last Name
Birth Date:

Month Day Year
Grade:
Gender:

Male Female
3. Student's Name:

First Name Last Name
Birth Date:

Month Day Year
Grade:
Gender:

Male Female
Parent/Guardian Information 1
Name: *

First Name Last Name
Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Home Number:

Area Code Phone Number
Cell Number: *

Area Code Phone Number
E-mail: *
Parent/Guardian Information 2
Name:

First Name Last Name
Home Number:

Area Code Phone Number
Cell Number:

Area Code Phone Number
E-mail:
example@example.com
Emergency Information
Emergency Contact's Name: *

First Name Last Name
Relationship:
Phone Number: *

Area Code Phone Number
Alt. Phone Number: *

Area Code Phone Number
Name:

First Name Last Name
Phone Number:

Area Code Phone Number
It is very important the parent/legal guardian keep all information on this sheet current at all times. It is also important that you inform emergency contacts who we are and you have placed their name on the Emergency Card.

Clear
Date:

Month Day Year
Date

Student Release Form

Consent to Photograph or Video

Read in Full Before Signing
Student's Name 1: *

First Name Last Name
Student's Name 2:

First Name Last Name
Student's Name 3:

First Name Last Name
I understand that my child my be photographed or videotaped by the staff of Kang’s MMA/USTMA while participating in the different programs offered at Kang’s MMA/USTMA. These may include Tae Kwon Do, sparring, grappling, Muay Thai (thai boxing), events happening during the Before and After School Program, Summer Camp which also may include field trips that are off location. This will also include Evening class, Brazilian Jiu Jitsu, competition and tournaments. May include parties and events taking place at Kang’s MMA/USTMA.

I further agree that any pictures or videos taken of my child, myself or other guests in connection with the events listed above can be used for publicity or for promotion without compensation at this time or at any other time to myself or my child or other family members.

I understand that the photographs and videos could appear on printed materials used by Kang’s/USTMA, Kang’s/USTMA website, Kang’s/USTMA Facebook page, Kang’s/USTMA Twitter page and or posted throughout the center on various bulletin boards for advertisement.

Kang’s MMA/USTMA is not responsible when other parents, students or guests who are videotaping or photographing their child, and your/my son/daughter is in that vicinity at Kang’s MMA/USTMA or any of the events listed above and have posted on their webpage, Facebook, Twitter page and more.
I DO UNDERSTAND AND AGREE TO THE TERMS ABOVE. *

I DO give permission for my child's image to be used by Kang's MMA/USTMA as described above and I do understand that I will not be compensated at this time or at any other time. I DO NOT give permission for my child's image to be used by Kang's MMA/USTMA as described above. I DO understand that when photographs and videotaping are being done my child will need to leave the area being used for this purpose.
Parent or Legal Guardian Name: *

First Name Last Name
Parent or Legal Guardian Signature:

Clear
Date:

Month Day Year
Date

Liability Waiver Relating to Coronavirus/COVID-19
I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and the State of Maryland and Montgomery/Prince George's County along with other public health authorities of Maryland still recommend practicing many safety measures when opening and operating a business. The medical knowledge is evolving day by day about the virus and how it is spread from person-to-person contact, or by contact with contaminated surfaces and objects or even possibly the air. The exact methods of the spreading Coronavirus/COVID-19 are unknown and there is no known treatment, cure, or vaccine. Kang's MMA & US Tiger Martial Arts cannot prevent you or your child[ren] from becoming exposed to, contracting, or spreading Coronavirus/COVID-19 while utilizing our services or visiting our premises. Kang's MMA/USTMA has put into place preventative measures to reduce the spread of the Coronavirus/COVID-19 by following the guidelines of the CDC and the State of Maryland and Montgomery/Prince George's County along with the other public health authorities of Maryland.· We will closely monitor daily for updates to protect our families, staff, students, and families against the spread and or contact from the Coronavirus/COVID-19.· Cleaning, social distancing other safety procedures have been put into place within the guidelines of the CDC of the State of Maryland and Montgomery/Prince George's County along with the other public health authorities of Maryland. · There may be a need to change daily schedules for our programs being offered to keep within the guidelines of the CDC of the State of Maryland and Montgomery/Prince George's County along with the other public health authorities of Maryland. · Parents must follow all procedures put into place by our staff in order to operate Kang's MMA & US Tiger Martial Arts according to the guidelines of the CDC and the State of Maryland and Montgomery/Prince George's County along with the other public health authorities of Maryland.· If student is experiencing any of the following symptoms: fever 100.4 or higher, unexplained body aches or pains, chills or without body aches, shortness of breath, non-allergy related runny nose, coughing, sore throat, headache, recent loss of smell or taste, unexplained sores on soles of feet, nausea, vomiting, or diarrhea, unusual fatigue or close contact with anyone with Coronavirus/COVID-19. DO NOT COME TO Kang's MMA/USTMA FOR CLASS.· Student or family has not traveled or had/have visitors from a highly infected area of the Coronavirus/COVID-19 from within the United States or other Countries. Therefore I or student is entering Kang's MMA/USTMA at his/her own risk, I or student agree that I or he/she do not have any of the above symptoms, I or student have not been diagnosed with the Coronavirus/COVID-19, I or student have not been exposed to the Coronavirus/COVID-19 within 14 days, I or student will be following all the CDC and the State of Maryland and Montgomery/Prince George's County along with other public health authorities of Maryland guidelines. I or student, my family, my heirs and my personal representatives hereby forever release and waive my rights to bring lawsuit against Kang's MMA & US Tiger Martial Arts, and it owners, instructors, directors, managers, and employees or other representatives in connections with exposure, infection, illness, medical treatment and expenses, bodily injury, death, personal injury or property loss or any other loss due to Coronavirus/COVID-19 while utilizing services and premises of Kang's MMA and US Tiger Martial Arts. This waiver will be in effect today and continue for 1-year to date of signature. If member terminates Membership Agreement this will close out the waiver and Kang's MMA/US Tiger Martial Arts will no longer be responsible for all above conditions listed from date of cancellation of Membership Agreement. *

YES I DO UNDERSTAND AND AGREE TO THE TERMS ABOVE
Signature

Clear
Name *

First Name Last Name
Date *

Month Day Year
Date
Should be Empty:

Tae Kwon Do Class

Liability Waiver Relating to Coronavirus/COVID-19