Karate Waiver
1
Martial Arts Classes - Student Records and Waiver Owen Johnston, Karate Instructor and Personal Trainer http://www.johnstonkarate.com Name:_______________________________________________________________ Date of Birth: ______________________ Address: ________________________________ City: ____________________ State: _____ Zip: __________ Home Phone: _________________________ Cell Phone: ____________________ E-Mail Address: ___________________ Sex: Male _____ Female _____ By signing this waiver of claims and liability, I acknowledge that I have read this agreement and will abide by all class rules set by Owen Johnston, and agree to wear all mandatory safety equipment. Signing this waiver also means that I release Owen Johnston from any liability in the case of injury as a result of the instruction under Owen Johnston. I recognize that martial arts and exercise carry some risk of injury (sprains, strains, bruises, dizziness, difficulty breathing, heart attack, bleeding), and that participation may result in other damage, due not only to my actions, inaction or negligence, but also to that of others associated with and/or present at these activities. I personally assume all risks involved or in any way related to my participation in these classes, whether known or unknown to me at the present time. Participation is voluntary and entirely of my own free will. I hereby represent and certify that I am aware of no medical problem – except as noted on the provided health questionnaire – that would increase risk of illness and injury as a result of participating in an ongoing martial arts or fitness program. If I do have any such conditions and would like to proceed with a martial arts or fitness program, I agree to obtain my physician's consent before doing so. I, my heirs, executors and successors hereby waive all claims of accidental and or negligent tort damages or injury against Owen Johnston, and any physical location where his classes are taught. All records are kept strictly confidential. Date __________________________________ Your signature, or parent / guardian signature (if you are under 18): ____________________________________________________________________ Instructor signature:_______________________________________________
description
http://www.johnstonkarate.com
Transcript of Karate Waiver
Martial Arts Classes - Student Records and WaiverOwen Johnston, Karate Instructor and Personal Trainer
http://www.johnstonkarate.com
Name:_______________________________________________________________
Date of Birth: ______________________
Address: ________________________________ City: ____________________
State: _____ Zip: __________ Home Phone: _________________________
Cell Phone: ____________________ E-Mail Address: ___________________
Sex: Male _____ Female _____
By signing this waiver of claims and liability, I acknowledge that I have read this agreement and will abide by all class rules set by Owen Johnston, and agree to wear all mandatory safety equipment. Signing this waiver also means that I release Owen Johnston from any liability in the case of injury as a result of the instruction under Owen Johnston. I recognize that martial arts and exercise carry some risk of injury (sprains, strains, bruises, dizziness, difficulty breathing, heart attack, bleeding), and that participation may result in other damage, due not only to my actions, inaction or negligence, but also to that of others associated with and/or present at these activities. I personally assume all risks involved or in any way related to my participation in these classes, whether known or unknown to me at the present time. Participation is voluntary and entirely of my own free will. I hereby represent and certify that I am aware of no medical problem – except as noted on the provided health questionnaire – that would increase risk of illness and injury as a result of participating in an ongoing martial arts or fitness program. If I do have any such conditions and would like to proceed with a martial arts or fitness program, I agree to obtain my physician's consent before doing so. I, my heirs, executors and successors hereby waive all claims of accidental and or negligent tort damages or injury against Owen Johnston, and any physical location where his classes are taught. All records are kept strictly confidential.
Date __________________________________
Your signature, or parent / guardian signature (if you are under 18):
____________________________________________________________________
Instructor signature:_______________________________________________
