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WAIVER FOR Adult_Karate Kid class

PACIFIC MARTIAL ARTS

(aka PMA, PMAF, Pacific Martial Arts Federation USA, Inc.)  

“We Teach Attitudes First!”

 

If trying our or joining the special class for parents and students, please fill this out. Payment is not required for the course at this time.

 

I, as a parent signing for my son(s) or daughter(s), or I as an adult participant signing for myself,  

 

(Names printed of participants)

 

agree for my child/children (or myself) to participate

in a trial karate class, series of classes, birthday party, camp, or other event of the Pacific

Martial Arts (PMA). I affirm that my child (or I) is (am) in good physical condition &

health, and further agree that I enter into this course of instruction freely & voluntarily. I

understand that said instruction involves physical contact & that there is a possibility of

physical injury associated with said instruction. Such injury can include but not limited to bruises, lacerations, bone injury, neck  and head

 injury, back injury, ankle sprains, bleeding, etc. The instructors will exhort you to do things. I assume the risk of any such physical

injury and agree that no action may be taken on account of any said injury against PMA,

and the PMA assignees, and the PMA officers, and its instructors and employees, except

in the event of gross negligence on the part of said school.

I hereby agree to indemnify and save harmless PMAF, Jerry Devine and his appointed instructors and volunteers against any and all liability, loss damages, costs, or expenses which they may incur or be required to pay as a result of my (or my son's or my daughter's) participation in the Pacific Martial Arts' activities.  I further agree not to make claim against any other person or corporation which mighty in turn make a claim against them. 

If submitting on line, you agree that this electronic submission will represent your authority as if you are signing this the and the form is to be submitted from your personal email.

 (Information is kept private!)

 

Parent Signature:          (not required if sending to us online)

 

Parent Name printed:       

 

Emergency phone          

 

Class or event date              

 

Location   Del Mar   Old Town   Other 

 

E-mail:         

 

Minor's birth-date (m/d/y)                       

 

Address:      

 

City and zip: 

You may use this form .... type in the boxes and hit submit one time.

Questions? Call 619-752-7515. In case you have problems submitting, please just copy and paste this information into your regular email and send to pma@pmakarate.com. Thank you.



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