REGISTRATION & LIABILITY WAIVER

Self-Defense Workshop

Contact Information

First Name *

Last Name *

Date of birth *

Gender

Male

Female

Other

Parent or Guardian Name(s) if applicable:

Phone *

Email *

Medical Release

Any medical problems?

Yes

If yes, please list:

On any medication?

Yes

If yes, please list:

Any allergies, or allergic to any medication?

Yes

Hospital Preference

Insurance Information

I agree that I/my child should consult with a physician before using these services and facilities. I/my child will not use the facilities with any

condition that threatens any person’s health or safety.

I authorize the necessary steps regarding medical attention (e.g., first aid, calling ambulance service for transportation to be admitted to the

hospital) and will allow authorized hospital staff to treat me/my child for any illness or injury.

SIGNATURE (Parent/legal guardian if applicable)

Clear

Waiver

I am fully aware of the inherent dangers in participating in activities involving Taekwondo and other martial arts. I understand and agree that Team

PRIDE and anyone associated with this program will not be responsible for my/my child’s safety.

In consideration for this membership, I assume any and all risks involved with martial arts training. I release forever Team PRIDE, Inc., its officers, directors, volunteers and partner schools, the American Taekwondo Association, their agents or assigns and any other individual or entity associated with this program, from liability, whether foreseen or unforeseen, arising out of my/my child’s participation in martial arts events or activities; including any harm, injury, or damage that may befall me/my child, my/my child’s family descendants, heirs or assigns while practicing or performing martial arts at any time or place, or while traveling to or from martial arts-related events, and any damage, loss or theft of any personal property.

INITIAL HERE.

In further consideration I agree that any photographs or videos taken of or by me/my child in connection with this membership can be used by Team PRIDE or its officers, directors, associates or assigns for publicity or promotion or any other purpose without compensation at this or any other time.

I have read this document and understand that it is a release of all liability and a waiver of the right to bring any claim for injury or loss arising out

of this program or its related activities. I understand that this agreement is valid for the duration of any and all of my/my child’s memberships in

Team PRIDE programs.

SIGNATURE for Waiver (Parent/legal guardian if applicable) *

Clear