CHILD'S NAME: *

First Name

Last Name

Child #2: (if applicable)

First Name

Last Name

Child #3: (if applicable)

First Name

Last Name

PARENT/GUARDIAN'S NAME: *

First Name

Last Name

CELL PHONE *

(###)

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WAIVER AND RELEASE: *

In consideration for my and my child’s participation in the martial arts training offered by Supreme Martial Arts, I the parent/guardian acknowledge the existence of certain inherent risks in this type of training and hereby agree to assume all risks. I further relieve Supreme Martial Arts, its management, and assigned staff from any liability resulting from personal injury or loss of personal belongings. I also hereby state that I and my child named above are physically fit to take the prescribed course of instruction and do so of our own free will for an agreed upon fee. In the event of an emergency, I hereby authorize any licensed medical personnel to perform any accepted medical procedure deemed necessary and agree to bear the expense of any such treatment. I hereby consent to Supreme Martial Arts taking photographs or video images of myself and my child while in classes and hereby irrevocably grant the right to use my and my child’s image or likeness in such images or photographs in any advertising, promotion, and marketing materials including any and all social media, print media, or on the website.

I AGREE TO THE WAIVER AND RELEASE.