Sign our waiver

General information:

Full name

Email

Phone Number

What date would like to schedule for your introductory class? (If today, mark today's date)

How did you hear about us?
Former studentReferred by studentWalk inSocial mediaWebsite

What Martial arts are you interested in? (Check all that apply)
Brazilian JiujitsuMMAJeet Kune DoKenpoKaliAikido

Do you have prior martial arts experience? If so, what have you practiced, how long did you practice, and what rank did you achieve?

Do you have any prior injuries?

Rules and Regulations:

As a student, I must faithfully comply with all the rules and safety regulations of the Academy. I further understand that all the classes are supervised by qualified personnel and that strict observation of safety regulation will largely preclude the possibility of accident and injury. Furthermore I am physically and mentally fit to participate in a course of martial art instruction and free of any communicable/infectious disease(s)
Acknowledge

Medical Release:
In the event of an emergency, Student or Guardian hereby authorizes transportation and licensed personnel to perform any accepted medical procedures on the Student deemed necessary or advisable, and agrees to bear the expense of such transportation or procedures.
Acknowledge
Release of Liability:
Martial arts instruction and self defense courses offered by Premier Shooting and Training Center, Jeet Kune Do Unlimited, Meyer Martial Arts, and its owners and employees (collectively Academy), will involve sparring and physical contact with other individuals, which may result in personal injury. Other programs offered by the Academy, including stick fighting and street grappling, also present a risk of personal injury to the participant. By signing below I am acknowledging my intent to release, waive, and discharge the Academy from any claim or liability for injury to my person or my child/children hereafter occurring at or around the Academy from any cause, whether or not such injury results from the active or passive negligence of the Academy. Accordingly, I, myself, and children, and for my and their successors, personal representatives, and assigns, hereby (I) release and waive any claims and causes of action against the Academy for personal injury, loss and /or consequential damage to me or my children resulting from the future passive or active negligence of the Academy in the operation, management, or supervision of the Academy and (I) agree to indemnify, defend, and hold the Academy free and harmless from any cost, loss, or liability arising out of any injury to myself or my children in or around the Academy proximity resulting from the negligence of the Academy. I further understand that I am not required to do any drill or exercise and can stop any drill at any time. I take responsibility for any training that I undertake.
Acknowledge
Are you 18 years or older?
I hereby certify that I am 18 years or olderI am signing as the Parent or Guardian of a student under the age of 18
Sign here:

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