Participant's Name
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First Name
Last Name
Participant's Date of Birth
*
MM
DD
YYYY
Guardian's Name
If the participant is under the age of 18. Otherwise leave blank.
First Name
Last Name
Email
*
Phone
*
If the participant is under 18 years old, please provide the guardian's phone number
(###)
###
####
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Requested Start Date
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Tuesday or Thursday; 5pm-6pm
MM
DD
YYYY
Any additional information?
Waiver
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In consideration of being allowed to participate in Kim’s Taekwon-Do Athletic Programs of Forest Grove and related events and activities, the undersigned acknowledges, appreciates and agrees that:
The risk of injury while participating in any Martial Art activity has the potential for significant injury. While following all school rules and using personal self-discipline may reduce the risk, there is always the possibility of serious injury.
I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown. EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, or others, and assume full responsibility for my participation.
I willing agree to comply with the stated and customary terms and conditions for participation. If I do observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest instructor or staff member immediately.
I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Kim’s Taekwon-Do, their directors, officers, officials, agents, volunteers and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (‘RELEASEES”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH , or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by the law.
I AM AT LEAST 18 YEARS OLD OR AM THE LEGAL GUARDIAN OF THE PARTICIPANT AND HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, AND FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
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WEBSITE AND MEDIA RELEASE
I, the undersigned, do hereby grant permission to Kim’s Taekwon-Do of Forest Grove to post my and/or my child’s story, photo, or other item, hereinafter referred to as “Materials,” I submit to and for the Kim’s Taekwon-Do Forest Grove web site, Twitter account (@forestgrovetkd), Instagram account (@forestgrovetkd), Facebook account, as well as other media publications for business purposes.
I hereby release you, your representative, employees, instructors, members, officers, parent companies, associated companies, and subsidiaries, from all claims and demands arising out of or in connection with any use of said “Materials”, including, without limitation, all claims for invasion of privacy, infringement of my right of publicity, defamation and any other personal and/or property rights.
I acknowledge and agree that no sums whatsoever will be due to me as a result of the use and/or exploitation of the “Materials” or any rights therein.
