Guest Participation Form

KOMA location you will be attending *

What event are you attending?

Accompanying KOMA Student *

First & last name

Event Date *

First Name *

Last Name *

Address

Street Address *

City

Postal Code

Phone *

Email *

How did you hear about us?

How many participants? *

Participant #1 Name *

Participant #1 Gender *

Participant #1 Age *

Participant #1 Birthdate *

Participant #2 Name *

Participant #2 Gender *

Participant #2 Age *

Participant #2 Birthdate *

Participant #3 Name *

Participant #3 Gender *

First and last name

Participant #3 Age *

Participant #3 Birthdate *

Participant #4 Name *

Participant #4 Gender *

Participant #4 Age *

Participant #4 Birthdate *

Participant #5 Name *

Participant #5 Gender *

Participant #5 Age *

Participant #5 Birthdate *

(Check box on left)

PARTICIPATION CONSENT AND LIABILITY

Before beginning any type of martial arts training or any kind of exercise program, you should first consult your physician. While training, serious injuries are possible, including sprains, strains, twists, cramps, and other injuries of similar magnitude. Individuals training in the martial arts can expect to encounter these injuries infrequently. The possibility of more serious injury exists, including fractured bones, broken bones, and torn ligaments, though not all martial artists encounter such serious injuries. As with any martial arts training or physical activity, there also exists the remote possibility of crippling or death. During any martial arts training or exercise if you feel dizzy or faint or experience any pain whatsoever, you must stop immediately and without delay seek the advice of a physician or health care professional.

In consideration of being allowed to participate in any way in martial arts instruction or training, and related events and activities, the undersigned:

1. Recognize and understand that martial arts training is a physical contact activity and that my participation might result in serious injury, including permanent disability or death, and severe social and economic loss.

2. Recognize and understand that such risk may be due to not only my own actions, but also the action, inaction or negligence of others, the regulations of participation, or the conditions of the premises, or of any of the equipment used.

3. Recognize that there may be other risks that are not known to me or to others or not reasonably foreseeable at this time.

4. Agree to inspect the facilities, equipment and pairings prior to participation. I will immediately inform an instructor if I believe that anything is unsafe or beyond my capability and refuse to participate.

5. Assume all of the foregoing risks and accept personal responsibility for any damages that may result from injury, permanent disability or death.

6. I certify that I or my child are in good physical condition, and have no disease, injury or other condition that would impair my performance or physical and mental well-being during intense training practice and/or competition.

7. Grant permission in case of injury to have a doctor, nurse, athletic training or other emergency medical personnel provide me with medical assistance or treatment for such injury.

8. Release, waive, discharge and covenant not to sue, Ko Martial Arts LLC, its affiliated organizations and governing bodies, their officers, instructors and personnel, other members of the organizations, participants, supervisors, coaches, sponsoring organizations or their agents, and if applicable, owners and leasers of the premises from any and all liability to the undersigned, his or her heirs and next of kin for any and all claims, demands, losses and damages which may be sustained and suffered on account of injury, including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the releases or otherwise. Ko Martial Arts, or any party designated by Ko Martial Arts, may photograph or film me/my student while I attend the premises of Ko Martial Arts and use of any and all such photos, video footage and/or video streaming for promotion, sales, publicity and advertising purposes for all media, including, but not limited to, the internet.