Participant Name * First and Last Name Date of Birth * MM DD YYYY Primary Contact Email * Primary Contact Phone * (###) ### #### Any Limitations Injuries, allergies, conditions, etc. Disclosure * I understand martial arts has inherent risks that could lead to serious injury or death. I am voluntarily participating and assuming any and all responsibility and risks associated with martial arts training . I, and any family or associates hereby waive any rights or claims that you might have to sue JKD·VT, Walker Wilder, any staff or associates. It is the sole responsibility of the participant or guardian to disclose any injuries, limitations or other heath risks that might be affected by your participation. It is recommended everyone consult a physician prior to any physical programs. I Understand Emergency Contact Name * First and Last Name - Must not be a participant Emergency Contact Email * Emergency Contact Phone * (###) ### #### E-Signature * Any and all information in this form is correct to the best of my ability and I am able to sign for the particiapnt. By clicking "Sign", I understand that constitutes a digital signature and my understanding of this agreement. Sign Date * MM DD YYYY Thank you! I’m excited to train together!
