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Karate Waiver

Karate Waiver

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Published by neo2868
karate waiver
karate waiver

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Published by: neo2868 on Aug 28, 2014
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08/28/2014

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Martial Arts Classes - Student Records and Waiver

Owen Johnston, Karate Instructor and Personal Trainer
http!!www"#ohnston$arate"co%
&a%e'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''
(ate o) *irth ''''''''''''''''''''''
Address '''''''''''''''''''''''''''''''' Cit+ ''''''''''''''''''''
State ''''' ,ip '''''''''' -o%e Phone '''''''''''''''''''''''''
Cell Phone '''''''''''''''''''' .-Mail Address '''''''''''''''''''
Se/ Male ''''' 0e%ale '''''
*+ si1nin1 this waiver o) clai%s and lia2ilit+, I ac$nowled1e that I
have read this a1ree%ent and will a2ide 2+ all class rules set 2+
Owen Johnston, and a1ree to wear all %andator+ sa)et+ e3uip%ent"
Si1nin1 this waiver also %eans that I release Owen Johnston )ro% an+
lia2ilit+ in the case o) in#ur+ as a result o) the instruction under
Owen Johnston" I reco1ni4e that %artial arts and e/ercise carr+ so%e
ris$ o) in#ur+ 5sprains, strains, 2ruises, di44iness, di))icult+
2reathin1, heart attac$, 2leedin16, and that participation %a+ result
in other da%a1e, due not onl+ to %+ actions, inaction or ne1li1ence,
2ut also to that o) others associated with and!or present at these
activities" I personall+ assu%e all ris$s involved or in an+ wa+
related to %+ participation in these classes, whether $nown or
un$nown to %e at the present ti%e" Participation is voluntar+ and
entirel+ o) %+ own )ree will" I here2+ represent and certi)+ that I
a% aware o) no %edical pro2le% 7 e/cept as noted on the provided
health 3uestionnaire 7 that would increase ris$ o) illness and in#ur+
as a result o) participatin1 in an on1oin1 %artial arts or )itness
pro1ra%" I) I do have an+ such conditions and would li$e to proceed
with a %artial arts or )itness pro1ra%, I a1ree to o2tain %+
ph+sician8s consent 2e)ore doin1 so" I, %+ heirs, e/ecutors and
successors here2+ waive all clai%s o) accidental and or ne1li1ent
tort da%a1es or in#ur+ a1ainst Owen Johnston, and an+ ph+sical
location where his classes are tau1ht" All records are $ept strictl+
con)idential"
(ate ''''''''''''''''''''''''''''''''''
9our si1nature, or parent ! 1uardian si1nature 5i) +ou are under :;6
''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''
Instructor si1nature'''''''''''''''''''''''''''''''''''''''''''''''

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