Park Dojo Student Info and Safety Waiver
Welcome to Park Dojo - your neighborhood martial arts program for kids! In order to participate in class, please fill out this student information form and safety waiver. Thank you!
Faça login no Google para salvar o que você já preencheu. Saiba mais
Student Full Name: *
Student's Birthday: (mm/dd/yy) *
Student's Home address: *
Parent's Name/Legal Guardian Name: *
Parent's Email: *
Parent's Phone Number: *
Has your child ever taken any martial arts lessons? If so, please name the most current belt rank they received. *
Does your child have an any allergies or medical conditions we need to be aware of? If yes, please decscribe below. *
Location you are interested in *
Student Safety Waiver and Consent
LIABILITY WAIVER: BECAUSE I ACKNOWLEDGE THE RISKS OF ATTENDING MYSELF OR ALLOWING MY CHILDREN TO PARTICIPATE, I AGREE TO RELEASE AND HOLD HARMLESS PARK DOJO AND ITS FOUNDER, TRUSTEES, DIRECTORS, OFFICERS, EMPLOYEES, AGENTS, AFFILIATES, VOLUNTEERS AND MEDICAL STAFF (“STAFF”) FROM ANY AND ALL INJURY CLAIMS OF ANY OTHER NATURE WHICH MAY RESULT FROM MY/MY CHILDREN’S PARTICIPATION AT AND TRAVEL TO OR FROM PARK DOJO. I AGREE TO INDEMNIFY AND HOLD PARK DOJO, ITS STAFF AND OTHER CHILDREN AT PARK DOJO HARMLESS FROM ANY AND ALL LIABILITY CAUSED BY MYSELF/MY CHILDREN, WHETHER OR NOT INTENTIONAL.

MEDICAL CONSENT: PARK DOJO WILL MAKE EVERY EFFORT TO CONTACT ME IN THE CASE OF AN EMERGENCY. I GIVE MY PERMISSION FOR PARK DOJO AND ITS MEDICAL STAFF TO ADMINISTER ANY MEDICATIONS NEEDED AND TO PROVIDE AND ARRANGE FOR ANY NECESSARY MEDICAL TREATMENT TO MYSELF/MY CHILDREN WHILE AT PARK DOJO, INCLUDING ONSITE AND OFFSITE EMERGENCY CARE. I ACCEPT RESPONSIBILITY FOR THE COSTS OF ALL SUCH MEDICAL TREATMENT.

PHOTOGRAPHY RELEASE: IN CONSIDERATION OF MY/MY CHILDREN’S PARTICIPATION AT PARK DOJO, AND WITHOUT ANY FURTHER CONSIDERATION FROM PARK DOJO, I HEREBY GRANT PERMISSION TO PARK DOJO, STAFF AND AFFILIATES TO UTILIZE MY APPEARANCE, PERFORMANCE OR VOICE IN ANY AND ALL MANNER AND MEDIA THROUGHOUT THE WORLD FOR THE PURPOSE OF PROMOTION, REPORTING OR PUBLICATION. PARK DOJO MAY USE MY/MY CHILDREN’S NAME, LIKENESS, VOICE AND BIOGRAPHICAL MATERIAL IN CONNECTION WITH PUBLICATION, PROMOTION, EXHIBITION AND DISTRIBUTION OF SUCH MATERIAL. I UNDERSTAND THAT NO ROYALTY, FEE OR ANY OTHER COMPENSATION OF ANY KIND SHALL BECOME PAYABLE TO ME BY REASON OF SUCH RELEASE AND USE OF ANY PHOTOGRAPH.

BY CHECKING THE BOX BELOW, I HAVE READ THIS FORM CAREFULLY AND HAVE HAD ALL QUESTIONS ANSWERED BEFORE SIGNING THIS LEGAL DOCUMENT AND GIVING THE CONSENTS AND WAIVERS CONTAINED IN IT. I ACKNOWLEDGE THAT THIS IS A LEGAL DOCUMENT AND I WILL BE BOUND BY MY AGREEMENT TO ITS TERMS.
Do you agree to the terms above? *
How did you find out about Park Dojo? *
Thank you for this information! We will reach out with any questions!
Enviar
Limpar formulário
Nunca envie senhas pelo Formulários Google.
Este formulário foi criado em Park Dojo. Denunciar abuso