Silverado Karate Registration Form

Kids Karate Program – 4 Weeks (6 and up) $49 Plus FREE Uniform

$49.00

LIMITED TIME ONLY!

We’re running an amazing web special on our Kids Martial Arts classes.

Fair warning: We’re in demand! Hurry before we are all filled up!

For literally thousands of years, Martial Arts have been taught to children around the world. But it’s not for the self-defense. It’s because Martial Arts help kids grow into great adults. They gain focus, discipline, and confidence in every class.

Kids Martial Arts Program

Please complete the form below.

Student Name*

Student Status* Returning Student New Student

Returning students, current belt level earned with Silvera Sensei:

Student Grade (Kyu)

Age*

Gender* Male Female

Parent/Guardian Name

Address (line 1)*

Address (line 2)

City, State, Zip*

Phone Number*

Email*

Emergency Contact Name*

Emergency Contact Phone*

Please list all allergies / medical conditions (if none, type N/A)*

Please select the class you(your) child will participate in:*

RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT

I have enrolled in the personalized health and fitness program offered through SILVERADO KARATE DOJO. I recognize that the program may involve strenuous physical activity including, but not limited to, muscle strength and endurance training, cardiovascular conditioning and training, and other various fitness activities. I hereby affirm that I am in good physical condition and do not suffer from any known disability or condition which would prevent or limit my participation in this exercise program. I acknowledge that my enrollment and subsequent participation in purely voluntary and in no way mandated by SILVERADO KARATE DOJO.”
“In consideration of my participation in this program, I hereby release SILVERADO KARATE DOJO and its agents from any claims, demands, and causes of action as a result of my voluntary participation and enrollment.” “I fully understand that I may injure myself as a result of my enrollment and subsequent participation in this program and I hereby release SILVERADO KARATE DOJO and its agents from any liability now or in the future for conditions that I may obtain. These conditions may include, but are not limited to, heart attacks, muscle strains, muscle pulls, muscle tears, broken bones, shin splints, heat prostration, injuries to knees, injuries to back, injuries to foot, or any other illness or soreness that I may incur, including death.
I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.

I have read the Release & Waiver of Liability and Indemnity Agreement

Electronic Signature of Student*

(If under 18 Electronic Signature of parent/guardian)*

Paypal

$49.00

LIMITED TIME ONLY!

Fair warning: We’re in demand! Hurry before we are all filled up!

Kids Martial Arts Program

Please complete the form below.

DOMO ARIGATO

どうもありがとう

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