Be Your Own Hero // Digital Registration and Waiver Form

Dear Parent/Guardian,

Please complete this form prior to your child’s first class. All information will be kept confidential.

We look forward to welcoming your child to our community!

Jess

Parent First Name *

Parent Last Name *

Email *

Emergency Contact Number *

Pick-up Person

Child's Name *

Child's Age *

Tshirt size

Name of friend or sibling (if signing up too)

Date of Joining (eg. Trial date/Winter 2026)

I understand that:

I am a parent/guardian having full legal responsibility for all decisions regarding my child;
I am familiar with the physical nature and possible risk of injury related to learning self-defense, including but not limited to: falls, bumps, bruises, scrapes, soreness, redness, sprains twists, physical stress, contact with other participants (where applicable) and other related injuries while participating in the program and beyond;
I acknowledge that physical contact with my child’s body is a part of learning and practicing self-defense. I understand that partner work with peers will involve physical contact and that instructors may make adjustments to assist in the proper application and understanding of a technique. Instructors will clearly ask participants for consent before using any physical touch and will proceed with appropriate care and consideration and within the public space;
My child is physically, emotionally and mentally able to participate in the program;
It is my child’s right and responsibility to inform the Arise instructor and/or group leader of any discomfort, pain, fatigue or any other symptom that may occur during the program and to sit out at their own discretion and comfort. First aid will be provided if needed and parent called.

I understand the above and permit my child to participate: *

Yes

I have questions

Is there anything we should know about your child to make this experience the most positive for them?

We occasionally take photos or short videos during class for program promotion (website, social media, grant applications). I consent to to my child being photographed/filmed. *

Yes

Yes, but want to approve them first

Arise has a newsletter for related news, resources and tips, special discounts and upcoming events. I authorize Arise to add my email to the mailing list. *

Yes

Already on it

Cancellation Policy: No refunds for missed classes. Credit will be offered on a case-by-case basis. Class credit will be provided if Arise needs to cancel. *

I acknowledge

How did you hear about us? *

By signing below, I understand that Be Your Own Hero is a physical program that may involve games, self-defense movements, and martial arts-based activities. I acknowledge that: My child participates voluntarily and is in suitable physical condition to do so Safety guidelines will be followed and facilitators will prioritize a safe, inclusive environment. I release Arise Programs, its facilitators, and partner venues from liability for any injuries or incidents arising from normal participation. I agree to communicate any concerns or changes in my child’s health or well-being that may affect their ability to participate safely. *

Yes

Signature

Clear