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Macon's Martial Arts release of Liability Waiver

In consideration for my attendance and participation in the martial arts training offered by this AFKA Certified School, I, the student/parent, acknowledge the existence of certain inherent risk in this type of training and hereby agree to assume all risk. I further relieve the school, its management, assigned staff and fellow students from any liability resulting from loss, whether personal belongings or bodily injury. I also hereby state, that myself or my child is physically fit to take the prescribed course of instruction and do so of my own free will in exchange for an agreed upon fee. I understand there is a no refund policy on any monies I will pay this martial arts school.

First Guest Name

First Name*

Last Name*

Phone*
First Guest Date of Birth*
First Guest Information

Medical Concerns/Past Injuries/Medications/Allergies
First Guest Signature*
Second Guest Name

First Name*

Last Name*
Second Guest Date of Birth*
Second Guest Information

Medical Concerns/Past Injuries/Medications/Allergies
Third Guest Name

First Name*

Last Name*
Third Guest Date of Birth*
Third Guest Information

Medical Concerns/Past Injuries/Medications/Allergies
Fourth Guest Name

First Name*

Last Name*
Fourth Guest Date of Birth*
Fourth Guest Information

Medical Concerns/Past Injuries/Medications/Allergies
Fifth Guest Name

First Name*

Last Name*
Fifth Guest Date of Birth*
Fifth Guest Information

Medical Concerns/Past Injuries/Medications/Allergies
Sixth Guest Name

First Name*

Last Name*
Sixth Guest Date of Birth*
Sixth Guest Information

Medical Concerns/Past Injuries/Medications/Allergies
Seventh Guest Name

First Name*

Last Name*
Seventh Guest Date of Birth*
Seventh Guest Information

Medical Concerns/Past Injuries/Medications/Allergies
Eighth Guest Name

First Name*

Last Name*
Eighth Guest Date of Birth*
Eighth Guest Information

Medical Concerns/Past Injuries/Medications/Allergies
Ninth Guest Name

First Name*

Last Name*
Ninth Guest Date of Birth*
Ninth Guest Information

Medical Concerns/Past Injuries/Medications/Allergies
Tenth Guest Name

First Name*

Last Name*
Tenth Guest Date of Birth*
Tenth Guest Information

Medical Concerns/Past Injuries/Medications/Allergies
Guest 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*

Confirm Email*
Check to receive information, and coupons by email.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Please provide the following information:

Today's Date *
Which of our schools do you plan to attend?*

Sponsor's Name *

Mother Phone

Father Phone
Please select the activity/activities you are participating in *
Free Introductory Lesson
Summer Camps
Birthday Party
Parent's Night Out
Fitness Boot Camp
Free Community Seminar
Did you hear from us at a school talk or daycare talk?

What is your teacher's name?
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.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Medical Concerns/Past Injuries/Medications/Allergies
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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