Trial Class for 3-4 Year Olds

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Name

Birthdate

Health Conditions

(List any physical handicaps)

Address

City

State / Province / Region

Zip Code

Phone

Age

Sex

Email

I agree to the liability waiver

I, the parent or guardian in consideration of my child's participation in martial arts lessons, do hereby assume all risk of personal injury. Acting for myself and/or child, my heirs, personal parties and assigns, I do hereby release the owners, instructors and visiting instructors of KRIEGISCH MARTIAL ARTS, branch dojos, owners of the property where said lessons are given, agents and organization from all liability including all claims at law, which may result directly or indirectly from my child's participation in said martial arts activity.

I agree to pay

I, the parent or guardian in consideration of my child's participation in martial arts lessons, do agree to pay the $29.95 amount due prior to the first trial class

Name of Parent/Guardian

Date