Signup

{name}

Emergency contact - {contact_name}  

Emergency contact phone - {contact_phone}  

Emergency contact relation - {contact_relation} 

Physical fitness waiver

             I {name}, the undersigned, being aware of my and/or my children's own health and physical condition and having knowledge that participation in any exercise program may be injurious to my health, am voluntarily participating in a physical activity.

                Having such knowledge, I hereby acknowledge this release, any representatives, agents, and successors from liability for accidental injury or illness which I may incur as a result of participating in the said physical activity. I hereby assume all risks connected therewith and consent to participate in said program.

                I agree to disclose any physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in said fitness program.

Photography/ Video waiver

I release the said student's likeness, thereby giving Smash Martial Arts all rights to film/photograph myself or children while present at Smash Martial Arts Cookeville TN or while participating in any activities, for use with advertisement and/or promotional purposes only. 

Full name Date document was signed {sign_date}

Student Name