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Character Martial Arts Liability Waiver

New Member ( ) Revision ( ) Renewal ( )

Student’s Name:________________________________________ Age:______ D.O.B.:____/____/____

Address: ______________________________ City: ________________ State: ______ Zip Code:_________
Email: _________________________________________ Cell Phone:(_______)-_______-____________ 



Parent/Emergency Contact 1:___________________________________ Relation to student:______________
Email: _________________________________________ Cell Phone:(_______)-_______-____________ 

Profession: ____________________________ Employer:__________________________________________


Parent/Emergency Contact 2:___________________________________ Relation to student:______________
Email: _________________________________________ Cell Phone.:(_______)-_______-____________ 

Profession: ____________________________ Employer:__________________________________________


What problems do you want the martial arts to solve for your child?

_________________________________________________________________________________________

Why are you here investing in martial arts for your child?

Who else do you know that would consider gaining the benefits of martial arts for their children?
Name: _________________________________________ Cell Phone:(_______)-_______-____________
Name: _________________________________________ Cell Phone:(_______)-_______-____________
Name: _________________________________________ Cell Phone:(_______)-_______-____________
Liability Waiver:
Student hereby represents that he/she is physically fit to take the prescribed course of instruction, that he/she has had
an opportunity to observe and/or participate in the art of self defense prior to the signing of this agreement, and that
no oral or written representations have been made to him/her except as expressly written in this agreement.
Student further acknowledges the existence for the potential of personal injury as a result of participating in an
activity such as Martial Arts, Karate, Tae Kwon Do, Hapkido, Fitness Kick-Boxing, Jiu-jitsu, Combat Grappling,
Wrestling, and Personal Fitness Training, and that he/she is assuming this risk without liability to Character Martial
Arts, Regis Tribbet or instructors by executing this agreement and participating in said course of instruction.
Students and parents, if applicable, agree to abide by the rules and regulations of the Character Martial Arts. It is
understood that failure to do so may result in the Student’s expulsion from martial arts classes.
Student has read and understands all the contractual terms set forth in this agreement.
Date: ____/_____/20____



Agreement accepted by: X_______________________________________________________________________