WAIVER FOR GUESTS AND PARTICIPANTS

Fill this form and

  • submit it on line, or
  • print out the form and submit it in person.

Field with a red asterisc (*) must be completed. We respect the privacy of your information: see our Privacy Policy.


This waiver is intended for the student (or others) taking part in the activities of the PACIFIC MARTIAL ARTS FEDERATION USA INC. (Also known in this agreement as PMA, PMAF, PACIFIC MARTIAL ARTS) including involvement in a regular class, camp, tournament, try out, orientation, self-defense seminars or any seminar, but not limited to these. The validity of this waiver is not limited to the date listed below but will be construed as covering subsequent visits for any period thereafter to allow for ease of scheduling subsequent visits.

I,  * (print your name here) as

or
 (please complete PART B below)
      Note: Only parents or legal guardians may sign for a minor.

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 daughter's) participation in the activities of theÊ Pacific Martial Arts Federation USA Inc. I further agree not to make a claim against any other person or corporation which mighty in turn make a claim against them.

I agree for myself or my child/children to participate in a trial karate class, series of classes, birthday party, camp, or other event of the Pacific Martial Arts (PMA) at one of its locations. I affirm that my child (or I) is (am) in good physical condition and health, and further agree that I enter into this course of instruction freely and voluntarily.

Parents and prospective students should realize that karate is a physical activity and that supervision is strict. Uncontrolled behavior, careless contact with punches and kicking is not permitted. All participants must realize that in spite of care, precaution and concern that accidental injury may occur by the very nature of the activity. Such injury may include but is not limited to bruises, lacerations, bone injury, neck and head injury, back injury, ankle sprains, bleeding, etc. 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.

During any sessions, the appointed instructors will require the student to perform physical actions involving strength, balance, focus, flexibility, stamina and more. The participant will be exhorted to go further, farther and harder. I understand that this can result in injury, accident, mental duress, or even death. By signing this form I agree to accept all risks associated with my (or my son's or daughter's) participation. In the case of sparring sessions, the risk is considerably more than usual due to the inherent nature of fighting and practicing the dangerous techniques with other people.

No participant should do any part of the activity that he or she feels is harmful to his or her well being in any way. If you do not feel comfortable with this form or the activity session you are about to undertake, do not sign this form. Otherwise the signatory fully understands and does accept all terms of this agreement.

If submitting on line: I agree that this electronic submission represents my authority as if I was signing in person and the email included is my personal email. (Please type your name in the box below in lieu of a signature.)

Signature:*   (Must match the name entered above)
Street Address:*    Suite: 
City:    State:     Zip:* 
Emergency Phone*  -  -    eMail:* 
Event:*    Event date:*  -  - 
Location:*        Specify: 
Note: This waiver remains in effect for any period thereafter and in the event of changes on the date(s) or venue(s).
PART B. If participant(s) are minor(s) please supply the following information.
  Child 1 Name   Date of birth:  -  - 
  Child 2 Name   Date of birth:  -  - 
  Child 3 Name   Date of birth:  -  - 

     

 

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Pacific Martial Arts
1010 University Ave. #264 San Diego CA 92103
Telephone: 619-299-8361