Shaw Martial Arts Waiver

I, the undersigned, hereby waive all claims against all persons connected with Shaw Martial Arts, NATF, Islamic Center of Irving or Valley Ranch Islamic Center for any injuries that I may sustain as a result or indirect result, of or during my participation in Karate class. I also assume full responsibility for any of my actions during class and in connection with what I have learned in class. I further agree that any pictures taken of or by me in connection with said school can be used by the school directors for publicity or promotion without compensation at this time or any other time.

First Student's Name

First Name*

Last Name*

Phone*

Select Gender

First Student's Date of Birth*

Date of Birth

First Student's Information

First Student's Signature*

Type Signature

Draw Signature

Click to Sign

Second Student's Name

First Name*

Last Name*

Select Gender

Student's Date of Birth*

Date of Birth

Second Student's Information

Third Student's Name

First Name*

Last Name*

Select Gender

Student's Date of Birth*

Date of Birth

Third Student's Information

Fourth Student's Name

First Name*

Last Name*

Select Gender

Student's Date of Birth*

Date of Birth

Fourth Student's Information

Fifth Student's Name

First Name*

Last Name*

Select Gender

Student's Date of Birth*

Date of Birth

Fifth Student's Information

Sixth Student's Name

First Name*

Last Name*

Select Gender

Student's Date of Birth*

Date of Birth

Sixth Student's Information

Seventh Student's Name

First Name*

Last Name*

Select Gender

Student's Date of Birth*

Date of Birth

Seventh Student's Information

Eighth Student's Name

First Name*

Last Name*

Select Gender

Student's Date of Birth*

Date of Birth

Eighth Student's Information

Ninth Student's Name

First Name*

Last Name*

Select Gender

Student's Date of Birth*

Date of Birth

Ninth Student's Information

Tenth Student's Name

First Name*

Last Name*

Select Gender

Student's Date of Birth*

Date of Birth

Tenth Student's Information

Student's 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*

For those who join the program

Would you like to be added to our WhatsApp group?*

Yes

Additional information

How did you find out about Shaw Martial Arts?*

Flyer / Brochure / Ad

Friend / Word of Mouth

Internet / Google search

Met Instructor

Other

Is there anything else you would like us to know?

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*

Select Gender

Parent or Guardian's Date of Birth*

Date of Birth

Parent or Guardian's Information

Parent or Guardian's Signature*

Type Signature

Draw Signature

Click to Sign

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.