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Karate PD Day or Camp Waiver 

(Misc: Day Sessions - School Sessions - Camps - PD Day)

ALL PARTICIPANTS ARE REQUIRED TO COMPLETE AND SIGN THIS PERMISSION SLIP TO ATTEND ANY FAMILY KARATE EVENT.

I HEREBY RELEASE FAMILY KARATE CENTRES AND ANY PERSONS ASSOCIATED WITH THIS EVENT IN ANY CAPACITY FROM ANY AND ALL LIABILITY DUE TO INJURY THAT MAY RESULT IN PARTICIPATION OF THIS EVENT. I CLEARLY UNDERSTAND THE PHYSICAL ASPECTS OF THIS SPORT AND AGREE TO ABIDE BY THE RULES ASSOCIATED WITH THIS EVENT AND ASSUME ALL RESPONSIBILITY AND LIABILITY FOR INFRINGEMENT OF SUCH RULES. I WARRANT THAT I AM OF SOUND HEALTH AND DO NOT SUFFER FROM ANY AILMENTS THAT I HAVE NOT MADE MENTION OF IN THIS DOCUMENT.

Today's Date: October 16, 2019

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information

Age

Medical Concerns (If Any)

Select the event start date: *
Which Location? *
North (1695 Wonderland Road N)
South (405 Wharncliffe Road S)
For PD Day or Camps: The staff at Family Karate on occasion venture to the park at lunch to allow for fresh air on full day events. I herby give my permission for such an outing. *
Yes
No
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Age

Medical Concerns (If Any)

Select the event start date: *
Which Location? *
North (1695 Wonderland Road N)
South (405 Wharncliffe Road S)
For PD Day or Camps: The staff at Family Karate on occasion venture to the park at lunch to allow for fresh air on full day events. I herby give my permission for such an outing. *
Yes
No
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

Age

Medical Concerns (If Any)

Select the event start date: *
Which Location? *
North (1695 Wonderland Road N)
South (405 Wharncliffe Road S)
For PD Day or Camps: The staff at Family Karate on occasion venture to the park at lunch to allow for fresh air on full day events. I herby give my permission for such an outing. *
Yes
No
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Age

Medical Concerns (If Any)

Select the event start date: *
Which Location? *
North (1695 Wonderland Road N)
South (405 Wharncliffe Road S)
For PD Day or Camps: The staff at Family Karate on occasion venture to the park at lunch to allow for fresh air on full day events. I herby give my permission for such an outing. *
Yes
No
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Age

Medical Concerns (If Any)

Select the event start date: *
Which Location? *
North (1695 Wonderland Road N)
South (405 Wharncliffe Road S)
For PD Day or Camps: The staff at Family Karate on occasion venture to the park at lunch to allow for fresh air on full day events. I herby give my permission for such an outing. *
Yes
No
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Age

Medical Concerns (If Any)

Select the event start date: *
Which Location? *
North (1695 Wonderland Road N)
South (405 Wharncliffe Road S)
For PD Day or Camps: The staff at Family Karate on occasion venture to the park at lunch to allow for fresh air on full day events. I herby give my permission for such an outing. *
Yes
No
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Age

Medical Concerns (If Any)

Select the event start date: *
Which Location? *
North (1695 Wonderland Road N)
South (405 Wharncliffe Road S)
For PD Day or Camps: The staff at Family Karate on occasion venture to the park at lunch to allow for fresh air on full day events. I herby give my permission for such an outing. *
Yes
No
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Age

Medical Concerns (If Any)

Select the event start date: *
Which Location? *
North (1695 Wonderland Road N)
South (405 Wharncliffe Road S)
For PD Day or Camps: The staff at Family Karate on occasion venture to the park at lunch to allow for fresh air on full day events. I herby give my permission for such an outing. *
Yes
No
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Age

Medical Concerns (If Any)

Select the event start date: *
Which Location? *
North (1695 Wonderland Road N)
South (405 Wharncliffe Road S)
For PD Day or Camps: The staff at Family Karate on occasion venture to the park at lunch to allow for fresh air on full day events. I herby give my permission for such an outing. *
Yes
No
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Age

Medical Concerns (If Any)

Select the event start date: *
Which Location? *
North (1695 Wonderland Road N)
South (405 Wharncliffe Road S)
For PD Day or Camps: The staff at Family Karate on occasion venture to the park at lunch to allow for fresh air on full day events. I herby give my permission for such an outing. *
Yes
No
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
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*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Age

Medical Concerns (If Any)

Select the event start date: *
Which Location? *
North (1695 Wonderland Road N)
South (405 Wharncliffe Road S)
For PD Day or Camps: The staff at Family Karate on occasion venture to the park at lunch to allow for fresh air on full day events. I herby give my permission for such an outing. *
Yes
No
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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