What Special Event are you registering for?

Participant Name:          Address:

City: State: Zip:

Phone: Emergency Phone:

Email:

Parents Names:        Cell Phone #:

Important Notes/Allergies/Medical Problems…etc:

Legal Information

I understand that under the terms of this agreement, East Coast Karate obligates itself to furnish me with competent instruction and suitable facilities for teaching lessons.

Qualified personnel, trained in the procedures and traditions of the Martial Arts supervise all class sessions. Official belt recognition and certification will be issued to me upon completion of the examinations.

The student hereby represents that he/she is physically fit to take the prescribed course of instruction and that he/she has had an opportunity to observe and/or participate in the above described art of self defense prior to signing this agreement.

Student recognizes further that strict observation of the rules and regulations relative to training include the use of protective equipment required by the institute.

This equipment will largely eliminate the possibility of accident or injury; however, the institute does not warrant the protective equipment.

Student understands that during the course of instruction, employees of East Coast Karate and/or other students or authorized personnel will be engaged in a course of conduct requiring physical contact, and he/she gives full consent to such contact as required by the training.

I understand and agree that East Coast Karate will not be held liable for any injuries, damages and/or death, caused by and/or not caused by or resulting from the negligence of the owners, operators, or persons in charge in said establishment, or their agents, servants, students or employees.

Parent/ Legal Guardian Signature:     Date: