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South OP

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.

Media Policy

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.

I HAVE READ THE ABOVE WARNING, WAIVER, RELEASE AND AGREEMENT TO PARTICIPATE. I UNDERSTAND ITS CONTENTS AND DO HEREBY SIGN IT VOLUNTARILY.


First Participant Name

First Name*

Last Name*

Phone*
First Participant Date of Birth*
First Participant Signature*
Second Participant Name

First Name*

Last Name*
Second Participant Date of Birth*
Third Participant Name

First Name*

Last Name*
Third Participant Date of Birth*
Fourth Participant Name

First Name*

Last Name*
Fourth Participant Date of Birth*
Fifth Participant Name

First Name*

Last Name*
Fifth Participant Date of Birth*
Sixth Participant Name

First Name*

Last Name*
Sixth Participant Date of Birth*
Seventh Participant Name

First Name*

Last Name*
Seventh Participant Date of Birth*
Eighth Participant Name

First Name*

Last Name*
Eighth Participant Date of Birth*
Ninth Participant Name

First Name*

Last Name*
Ninth Participant Date of Birth*
Tenth Participant Name

First Name*

Last Name*
Tenth Participant Date of Birth*
Participant Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*
Would you like to receive upcoming free events and promotions from us?
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Date of event/class you are attending?

Date *
Event Type?
Birthday Party
Boy/Girl Scout Class
Self Defense Class
Other Event
Would you like to be contacted about our programs?
Yes, by email
Yes, by text
Yes, by phone
No thank you
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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