KungFu Dragon USA Try Out Form - San Ramon
Welcome to Kungfu Dragon USA!
 
KungFu Dragon USA has been a leading Chinese martial arts school serving the Tri-Valley community for over 10 years and have won the Best of Martial Arts School Award for 6 consecutive years.

Kungfu isn’t just a sport it’s a way of life.

What we teach:
Shaolin KungFu   (少林功夫)
Modern Wushu    (现代武术)
Weapon Forms    (十八般兵器)
Street Self-defense  (实战防身格斗)
Grappling & wrestling (擒拿&摔跤)
Meditation & Concentration (冥想打坐)

Benefits of KungFu :
Respect尊重
Strength 强壮
Discipline 纪律
Weight loss修身
Self-defense 自卫
Self-confidence 自信
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Student Information
Student's Full Name *
Gender *
Age *
Parent/Guardian Name *
If adult 18+, input N/A
Cell Number *
If under 18, please provide Parent/Guardian cell number
Email Address *
If under 18, please provide Parent/Guardian email
Previous Experience *
What areas would you like to improve? (check as many as apply) *
Required
San Ramon Try Out Class & Schedule
Try Out Class
Please select level and day of week based on schedule above
Tuesday
Thursday
Friday
Saturday
Sunday
Little Dragons (ages 3-7)
Beginner I (ages 8-12)
Adult/Teen (13+)
Clear selection
Try Out Date *
Please let us know which date you'll be coming to for your Try-Out Class
MM
/
DD
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YYYY
Health & Emergency
Health or Physical Condition *
If you have a health or physical condition, or had recent surgery, do you understand that you are urged to consult with a physician and receive medical clearance before starting a martial arts program?
Required
Please indicate any special needs or specific actions that we should be aware of in the event of an emergency. (i.e. allergy to certain medications such as penicillin etc.) *
If none, write N/A
Liability Release and Waivers
YES, I grant KFDUSA the right to use and reproduce any photographs, audio, and visual recordings of myself or members of my family for any lawful purpose, including but not limited to advertising, promotion, trade, or marketing communication material, including print brochures and online websites. *
In exchange for participation in the activity of Martial Arts and other activities organized by KungFu Dragon USA (“KFDUSA”), of 7059 Commerce Cir # I, Pleasanton, CA 94588 and/or use of the property, facilities and services of KFDUSA, I agree for myself and (if applicable) for the members of my family, to the following:
1. I agree to observe and obey all posted rules and warnings, and further agree to follow any oral instructions or directions given by KFDUSA, its officers, employees, instructors, representatives, or agents.

2. I understand that martial arts can be a strenuous form of exercise. I understand that it is my responsibility to obtain a physical examination before starting a martial arts program, to regularly consult with my doctor or health care professional, and to regularly monitor my own condition and equipment at all times.

3. I understand that martial arts training involves physical activity and that my participation might result in injuries. Therefore, I assume all risks and responsibilities of any injury or damage incurred while engaging in any martial arts or physical exercise activity, class, program, instruction, or event on the premises or at special events off the premises, including the use of any martial arts equipment.

4. I understand that there are certain inherent risks associated with martial arts activities and other types of exercise. I further understand that such risks may be known and unknown: these risks may be due to my own actions as well as the action, inaction or negligence of others, the regulations of participation, the conditions of the premises or equipment used. I assume full responsibility for any and all personal injury to myself or to others, and further release and discharge KFDUSA, its officers, employees, instructors, representatives, or agents, for injury, loss or damage arising out of my or my family's use of or presence upon the facilities of KFDUSA, whether caused by the fault, action, inaction or negligence of myself, my family, KFDUSA or other third parties.

5. I agree that in the event of an injury, I give permission to employees, instructors, or others at KFDUSA to use first aid and CPR in any circumstance in which they judge is necessary; to arrange for all necessary medical treatment for which I shall be financially responsible; and to seek or authorize appropriate medical treatment or attention on behalf of myself or my child as may be required by the circumstances, including without limitation, that of a licensed medical physician and/or a hospital. This authority begins on the date signed and continues indefinitely.

6. I understand that I am voluntarily releasing my rights to seek compensation for all manner of damages that I may otherwise have had. On behalf of myself and my spouse/partner, children, parents, guardians, heirs, next of kin, personal representatives, assigns and estate, I hereby voluntarily and forever release and discharge KFDUSA, its officers, employees, instructors, representatives, or agents from, and agree not to sue KFDUSA, its officers, employees, instructors, representatives, or agents, for any and all present and future claims, demands, actions, causes of action, damages, losses or any other alleged liabilities or obligations, whether known or unknown, for any injuries to me or my child while engaging
in any activity at KFDUSA which arise out of, result from or are caused by, the negligence of KFDUSA, its officers, employees, instructors, representatives, or agents. I understand and agree that this Release shall apply even if it is determined, or could be determined, that KFDUSA, its members, owners, instructors, business invitees, other students, and participants in martial arts activities caused or partially caused, the damages and/or injuries I sustained, even if my damages or injury was caused intentionally and/or negligently.

7. I agree to pay for all damages to the facilities of KFDUSA caused by my or my family's negligent, reckless, or willful actions. I agree that KFDUSA is not responsible for personal property that is lost, stolen, or damaged while in, on, or about the premises, including personal property that may be stored in the lockers. I agree that any legal or equitable claim that may arise from participation in martial arts activities shall be resolved under California law.

8. I agree that if any portion of this Release is found unenforceable or invalid by a Court of Law, the remainder of the Release shall continue in full legal force and effect. I agree that if legal action is taken for any reason, KFDUSA shall be entitled to reasonable attorneys’ fees for the enforcement of this Release.
I have read this Release in its entirety. I understand that this Release is legally binding and releases KFDUSA from negligence to
the fullest extent permitted by law. By signing this Release, I understand that I am giving up or waiving any right that I may otherwise have to bring legal action against KFDUSA, its officers, employees, instructors, representatives, or agents. I also understand this Release cannot be modified orally. This Release is effective from the date signed below. Parent or Guardian (if Member is nder 18): I am the parent or legal guardian of the above named minor child and, as such, I am authorized to sign this Release. I agree that my minor child and I are bound by and subject to the terms of this Release and Waiver of Liability.
Please read the above Liability Release and select YES to agree. If you are under 18, please confirm you are the parent/guardian filling out the form. *
How did you hear about us? *
If you saw us at an event, please indicate in "other". (i.e. Dublin Splatter)。 If you can't remember the name of the event, please write "event".
Referred by:
If selected Student or Friend Referral above, please write their full name below (i.e.: if referred by Alex Wang, write "Alex Wang" in the blank.)
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