Loading...

In consideration of being permitted to participate at Eastside Martial Arts (including functions, which include: traveling to and from events, clinics, camps, birthday parties, special practice sessions, tournaments and related events and activities, I hereby, 

1. Acknowledge that I am familiar with the martial arts and understand the rules governing special activities and the importance of following the rules at Eastside Martial Arts. 

2. Agree that prior to practice, I will inspect mats, equipment, facilities, etc. and if I believe anything to be unsafe or beyond my capability, I will immediately notify the person in charge and refuse to participate.

3. Acknowledge and fully understand that I will be engaged in a contact activity that might result in serious injury including permanent disability or death, and severe social and economic losses due to not only my action, inaction, or negligence, but also to the action, inaction and negligence of others, the rules of the sport/art, or conditions of the premises or any equipment used. Further, I acknowledge that there may be other risks not known to me or not reasonably foreseen at this time. 

4. Knowing the risks involved in the martial arts, assume that risk and accept personal responsibility for the damages following such injury. 

5. Release, waive, discharge and covenant not to sue Eastside Martial Arts, its organizers, and its committees, together with affiliate organizations, officials, sponsoring agencies, sponsors, advertisers, and if applicable, owners, lessors, and lessees or premises used to conduct special events, and regular programs, all of whom are hereby called "releasees," from any and all claims, demands, losses, or damages on the account of injury, including permanent disability and death and damage to property, caused or alleged to be cause in whole or in part by negligence of releasees or otherwise. 

6. Have checked with my physician and have been given a clean bill of health to participate in Martial Arts activities. 

7. Will be personally responsible for any damages to property at Eastside Martial Arts, due to use, misuse or negligence. 

8. Agree to never abuse my knowledge. If I am terminated in bad standings at Eastside Martial Arts; I agree to return all rank certifications with NO REFUND to myself. 

9. Promise never to instruct anyone in martial arts without the permission of the head instructor.

10. Grant permission to have my minor child, in the event of an emergency, treated at a legal hospital facility if I cannot be reached. 

Parent(s) or legal guardian(s) of minor members (under the age of 18) additionally agree that they will instruct their minor participant to the above warnings and stipulations of membership and their ramifications, and they consent to the minor's participation. 

I, having read this warning, waiver and release, understand that I give up substantial rights by signing it and knowing this, sign it freely and voluntarily. I agree to participate knowing the risks and conditions involved and do so of my own free will. 

May 26, 2022

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 Signature*
Second Participant's Name

First Name*

Last Name*

Phone*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*

Phone*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*

Phone*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*

Phone*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*

Phone*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*

Phone*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*

Phone*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*

Phone*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*

Phone*
Tenth Participant's Date of Birth*
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*
Group/Event

Which group/event are you with?
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 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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!