Evening Martial Arts Program Registration Form

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

If the same as above enter name, e-mail and phone information only

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:

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 may be photographed or videotaped by the staff of Kang’s MMA while participating in the different programs offered at Kang’s MMA. These may include Tae Kwon Do, sparring, grappling, Muay Thai (thai boxing), events happening during the After CareProgram, 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. Several of the classes listed above are not be offered at this time due to COVID-19. We ae not sure when these programs will open.

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 promotion without compensation at this time or at any time to myself or my child or other family members now or in the future.

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

Kang’s MMA 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 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 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 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:

Date

I acknowledge the contagious nature of the Coronavirus/COVID-19 has been declared a worldwide pandemic by the World Health Organization, the CDC and the State of Maryland and Montgomery County along with other public health authorities of Maryland and has recommended practicing 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 still unknown. A vaccine has been developed and currently being offered to people starting at age 12 and up. People reportedly can be infected and show no symptoms and therefore spread the disease.

Kang's MMA 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. It is not possible to prevent against the presence of the disease. Therefore, if you choose to utilize Kang's MMA services and or enter onto Kang's MMA premises you may be exposing yourself, and your child(ren) to and or increasing your risk of contracting or spreading Coronavirus/COVID-19.

Kang's MMA has put into place preventative measures to help reduce the spread of the Coronavirus/COVID-19 by following the guidelines of the CDC and the State of Maryland and Montgomery County along with the other public health authorities of Maryland. We will monitor daily for updates to protect our families, staff, and students, against the spread and or contact from the Coronavirus/COVID19 by proper cleaning, social distancing and other safety procedures in place and working with all families, and students to follow all procedures put into place by to safely operate Kang's MMA through this Coronavirus/COVID-19 pandemic.

WAIVER OF LAWSUIT/LIABILITY: I, my family, my heirs and my personal representatives hereby forever release and waive my rights to bring suite against Kang's MMA, and it owners, instructors, directors, managers, and employees trustees or other representatives in connection with exposure, infection, illness, and or spread of Coronavirus/COVID-19 related to utilizing Kang's MMA sevices and premises. I understand that this waiver means that I give up my right to bring any claims including for medical treatment and expenses, bodily injury, death, personal injury or property loss or any other loss, including but not limited to claims of negligence and give up any claim I may have to seek damages, whether known or unknown, foreseen or unforeseen due to Coronavirus/COVID-19.

This waiver will be in effect today and terminate at the close of the Membership Agreement. Kang's MMA willnot be resposible for all above conditions listed from date of cancellation up to 1 (one year) of Membership Agreement.

*

I HAVE CAREFULLY READ AND FULLY UNDERSTAND THE PROVISION OF THIS REALEASE AND FREELY AND KNOWINGLY ASSUME THE RISKY AND WAIVE MY RIGHTS CONCERNING LIABILITY AS DESCRIBED ABOVE.

Signature

Clear

Name *

First Name Last Name

Date *

Date

Tae Kwon Do Class

Liability Waiver Relating to Coronavirus/COVID-19