Shogun Martial Arts Release Form

Type of visit*

How did you hear about us?

Social MediaOnline ResearchA Shogun EventCurrent Member / Other (please describe)

Name of visitor*

First NameLast NameSuffix

Visitor's Date of Birth*

Any medical concerns?

NoYes (please describe)

Visitor's Age is under the required 18+ years of age to sign this form.

A parent/guardian MUST sign on behalf of the visitor below.

Age*

Do you know someone who trains here?

Date - autofill

Date

Are you signing this Release Form for more than one person?*

Person 2 - Name

First NameLast Name

Person 2 - Age

Person 3 - Name

First NameLast Name

Person 3 - Age

Person 4 - Name

First NameLast Name

Person 4 - Age

Email Address*

Required to obtain a confirmation receipt of this form

Phone Number*

In consideration for our attendance and participation in this studio’s martial arts training, I, the student/parent/guardian, acknowledge the existence of certain inherent risks in this type of training and hereby agree to assume all risks. I further relieve the studio, its management, assigned staff, and fellow students from any liability resulting from personal injury or loss of personal belongings. I also hereby state the students named above are physically fit to take the prescribed course of instruction, do so of their own free will, and will oblige by posted rules, regulations, and instructions by Shogun staff members.

By submitting this form, I also hereby agree and grant Shogun Martial Arts, LLC permission to use my likeness in photographs, video, or other digital media in any and all of its publications, including web-based publications / social media, without payment or other consideration. I waive any right to inspect or approve the finished product wherein my likeness appears, and I understand and agree that all photos will become the sole property of Shogun Martial Arts, LLC., and sharable upon request.

Parent/Guardian Name (required if visitor is under 18+ years of age)

First NameLast Name

Today's Date*

Date

Signature*

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